Provider Demographics
NPI:1093424947
Name:GEORGE, GARY SCOTT
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:SCOTT
Last Name:GEORGE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 BURTON ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-1203
Mailing Address - Country:US
Mailing Address - Phone:907-799-7872
Mailing Address - Fax:907-563-2045
Practice Address - Street 1:1432 INGRA ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-5434
Practice Address - Country:US
Practice Address - Phone:907-562-7900
Practice Address - Fax:907-563-2045
Is Sole Proprietor?:No
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist