Provider Demographics
NPI:1164502829
Name:KRIMM, TAMARA M (MD FAAP)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:M
Last Name:KRIMM
Suffix:
Gender:F
Credentials:MD FAAP
Other - Prefix:
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Mailing Address - Street 1:3750 E COUNTRY FIELD CIRCLE
Mailing Address - Street 2:C
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654
Mailing Address - Country:US
Mailing Address - Phone:907-357-2955
Mailing Address - Fax:907-357-9376
Practice Address - Street 1:3750 E COUNTRY FIELD CIRCLE
Practice Address - Street 2:C
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:907-357-2955
Practice Address - Fax:907-357-9376
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK4733208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD7760Medicaid
H43516Medicare UPIN