Provider Demographics
NPI:1467432278
Name:GAUPP, MONICA CLAUDIA (MD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:CLAUDIA
Last Name:GAUPP
Suffix:
Gender:F
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:PO BOX 771455
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-1455
Mailing Address - Country:US
Mailing Address - Phone:907-622-9900
Mailing Address - Fax:907-622-4038
Practice Address - Street 1:16958 N EAGLE RIVER LOOP RD
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577
Practice Address - Country:US
Practice Address - Phone:907-622-9900
Practice Address - Fax:907-622-4038
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAK4872208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD47581Medicaid
AK4872OtherSTATE OF ALASKA