Provider Demographics
NPI:1326076837
Name:MAYER, JOHN RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RICHARD
Last Name:MAYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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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
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-08-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AK2974208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKH20153Medicare UPIN