Provider Demographics
NPI:1548201395
Name:DEMAIN, JEFFREY G (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:G
Last Name:DEMAIN
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 1:3841 PIPER ST
Mailing Address - Street 2:SUITE T4-054
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508
Mailing Address - Country:US
Mailing Address - Phone:907-562-6228
Mailing Address - Fax:907-562-6868
Practice Address - Street 1:3841 PIPER ST
Practice Address - Street 2:SUITE T4-054
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-562-6228
Practice Address - Fax:907-562-6868
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3979207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD39794Medicaid
AKMD39792Medicaid
AKMD39794Medicaid
AK152352Medicare ID - Type Unspecified
AKG85990Medicare UPIN