Provider Demographics
NPI:1336145788
Name:DERAMUS, ALFRED DAVID (MD)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:DAVID
Last Name:DERAMUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4001 GEIST RD
Mailing Address - Street 2:STE 9
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-3569
Mailing Address - Country:US
Mailing Address - Phone:907-479-0852
Mailing Address - Fax:907-479-0859
Practice Address - Street 1:4001 GEIST RD
Practice Address - Street 2:STE 9
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-3569
Practice Address - Country:US
Practice Address - Phone:907-479-0852
Practice Address - Fax:907-479-0859
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2009-11-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AKMD1850207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD1850Medicaid
AKMD1850Medicaid