Provider Demographics
NPI:1093041303
Name:MARCUS C DEEDE MD
Entity Type:Organization
Organization Name:MARCUS C DEEDE MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:C
Authorized Official - Last Name:DEEDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-262-9341
Mailing Address - Street 1:265 N BINKLEY ST
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7523
Mailing Address - Country:US
Mailing Address - Phone:907-262-9341
Mailing Address - Fax:907-262-1545
Practice Address - Street 1:265 N BINKLEY ST
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7523
Practice Address - Country:US
Practice Address - Phone:907-262-9341
Practice Address - Fax:907-262-1545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1761207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMPG0069Medicaid
AKMPG0069Medicaid