Provider Demographics
NPI:1104860261
Name:VARALLO, JOHN E (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:VARALLO
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 TONGASS AVE
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-5746
Mailing Address - Country:US
Mailing Address - Phone:907-228-8300
Mailing Address - Fax:907-228-8518
Practice Address - Street 1:3100 TONGASS AVE
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5746
Practice Address - Country:US
Practice Address - Phone:907-228-8300
Practice Address - Fax:907-228-8518
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD21361207V00000X
AK6136207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ104410Medicaid
AKMD4127Medicaid
G68778Medicare UPIN
AKK160910Medicare PIN