Provider Demographics
NPI:1285676841
Name:MAYER CLINIC INCORPORATED
Entity Type:Organization
Organization Name:MAYER CLINIC INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:MAYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-457-5050
Mailing Address - Street 1:1867 AIRPORT WAY
Mailing Address - Street 2:SUITE 120B
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4007
Mailing Address - Country:US
Mailing Address - Phone:907-457-5050
Mailing Address - Fax:907-457-5034
Practice Address - Street 1:1867 AIRPORT WAY
Practice Address - Street 2:SUITE 120B
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4007
Practice Address - Country:US
Practice Address - Phone:907-457-5050
Practice Address - Fax:907-457-5034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3960207Q00000X
AK2974208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKH20153Medicare UPIN
AKG19367Medicare UPIN