Provider Demographics
NPI:1184849242
Name:LONDON, ALEXANDR (NP)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDR
Middle Name:
Last Name:LONDON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1793 CONCORD HILL DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-2542
Mailing Address - Country:US
Mailing Address - Phone:907-337-5803
Mailing Address - Fax:907-339-1999
Practice Address - Street 1:1793 CONCORD HILL DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-2542
Practice Address - Country:US
Practice Address - Phone:907-337-5803
Practice Address - Fax:907-339-1999
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
AK171M00000X
AK1003363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No251B00000XAgenciesCase Management
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCM5856Medicaid
AK428642OtherALASKA BUSINESS LICENSE