Provider Demographics
NPI:1235144916
Name:MCANINCH, JANA K (MD)
Entity Type:Individual
Prefix:DR
First Name:JANA
Middle Name:K
Last Name:MCANINCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 CRIPPLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-2201
Mailing Address - Country:US
Mailing Address - Phone:907-451-0661
Mailing Address - Fax:
Practice Address - Street 1:2050 CRIPPLE CREEK RD
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-2201
Practice Address - Country:US
Practice Address - Phone:907-451-0661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4658207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKH66744Medicare UPIN