Provider Demographics
NPI:1497713572
Name:WALIS, BARBARA B (DO)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:B
Last Name:WALIS
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:6000 KANAKANAK RD
Mailing Address - City:DILLINGHAM
Mailing Address - State:AK
Mailing Address - Zip Code:99576
Mailing Address - Country:US
Mailing Address - Phone:907-842-5201
Mailing Address - Fax:907-842-9250
Practice Address - Street 1:6000 KANAKANAK RD
Practice Address - Street 2:
Practice Address - City:DILLINGHAM
Practice Address - State:AK
Practice Address - Zip Code:99576
Practice Address - Country:US
Practice Address - Phone:907-842-5201
Practice Address - Fax:907-842-9250
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK4429207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
8EZ604OtherCLARKS POINT
8EZ663OtherKING SALMON
8EZ693OtherMANOKOTAK
8EZ723OtherPERRYVILLE CLINIC
8EZ743OtherPILOT POINT CLINIC
8EZ505OtherN ALEKNAGIK
8EZ534OtherS ALEKNAGIK
8EZ733OtherPORT HEIDEN
8EZ524OtherKANAKANAK
8EZ544OtherCHIG LAGOON
8EZ653OtherIVANOFF BAY
8EZ643OtherIGIUGIG CLINIC
8EZ703OtherNAKNEK CLINIC
8EZ673OtherKOLIGANEK
8EZ713OtherNEW STUYAHOK
8EZ683OtherLEVELOCK CLINIC
8EZ515OtherCHIG LAKE
8EZ623OtherEKWOK CLINIC
8EZ643OtherIGIUGIG CLINIC
8EZ703OtherNAKNEK CLINIC