Provider Demographics
NPI:1114548351
Name:ALASKA FACIAL PLASTIC SURGERY & ENT
Entity Type:Organization
Organization Name:ALASKA FACIAL PLASTIC SURGERY & ENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-422-9716
Mailing Address - Street 1:3719 E MERIDIAN LOOP STE E
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7273
Mailing Address - Country:US
Mailing Address - Phone:079-671-6017
Mailing Address - Fax:907-631-0766
Practice Address - Street 1:3340 PROVIDENCE DR # A363
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4691
Practice Address - Country:US
Practice Address - Phone:907-671-6017
Practice Address - Fax:907-313-6857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-28
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty