Provider Demographics
NPI:1295829745
Name:BURSELL, JOHN PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PATRICK
Last Name:BURSELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3220 HOSPITAL DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7808
Mailing Address - Country:US
Mailing Address - Phone:907-364-2663
Mailing Address - Fax:907-364-2662
Practice Address - Street 1:3220 HOSPITAL DR
Practice Address - Street 2:SUITE 101
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7808
Practice Address - Country:US
Practice Address - Phone:907-364-2663
Practice Address - Fax:907-364-2662
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK3748208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD05232Medicaid
AKMD05231Medicaid
AKMD05231Medicaid