Provider Demographics
NPI:1407965288
Name:PACKER, LOUIS M (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:M
Last Name:PACKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:185 E PARKS HWY
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7038
Mailing Address - Country:US
Mailing Address - Phone:907-373-4200
Mailing Address - Fax:907-373-4201
Practice Address - Street 1:185 E PARKS HWY
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7038
Practice Address - Country:US
Practice Address - Phone:907-373-4200
Practice Address - Fax:907-373-4201
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK3064207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKC97196Medicare UPIN
AK05WCQHGAMedicare ID - Type Unspecified