Provider Demographics
NPI:1356630867
Name:GUZIEJEWSKI, THOMAS WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WALTER
Last Name:GUZIEJEWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 E NORTHERN LIGHTS BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4154
Mailing Address - Country:US
Mailing Address - Phone:907-336-2273
Mailing Address - Fax:
Practice Address - Street 1:2110 E NORTHERN LIGHTS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4154
Practice Address - Country:US
Practice Address - Phone:907-336-2273
Practice Address - Fax:907-336-2276
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3595208D00000X
WA0036955208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD9719Medicaid