Provider Demographics
NPI:1265509681
Name:OSWALD, MAURY ALLEN (DO)
Entity Type:Individual
Prefix:
First Name:MAURY
Middle Name:ALLEN
Last Name:OSWALD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E DIMOND BLVD
Mailing Address - Street 2:#12
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-1908
Mailing Address - Country:US
Mailing Address - Phone:907-341-7727
Mailing Address - Fax:907-341-7760
Practice Address - Street 1:300 E DIMOND BLVD
Practice Address - Street 2:#12
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-1908
Practice Address - Country:US
Practice Address - Phone:907-341-7727
Practice Address - Fax:907-341-7760
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2781207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD2781Medicaid
AKF36209Medicare UPIN
AK08WCHNMJMedicare ID - Type Unspecified