Provider Demographics
NPI:1275993685
Name:DENALI ASTHMA AND PULMONARY LLC
Entity Type:Organization
Organization Name:DENALI ASTHMA AND PULMONARY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:MERLE
Authorized Official - Last Name:SHOTWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-325-0583
Mailing Address - Street 1:3202 INTERNATIONAL ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-7392
Mailing Address - Country:US
Mailing Address - Phone:907-328-0583
Mailing Address - Fax:907-325-0586
Practice Address - Street 1:3202 INTERNATIONAL ST
Practice Address - Street 2:SUITE 201
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-7392
Practice Address - Country:US
Practice Address - Phone:907-328-0583
Practice Address - Fax:907-325-0586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-26
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK7517207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty