Provider Demographics
NPI:1598732042
Name:GRUCHACZ, PAMELA A (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:A
Last Name:GRUCHACZ
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 1:3225 HOSPITAL DRIVE
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801
Mailing Address - Country:US
Mailing Address - Phone:907-796-8700
Mailing Address - Fax:907-796-8710
Practice Address - Street 1:3225 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 101A
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801
Practice Address - Country:US
Practice Address - Phone:907-796-8700
Practice Address - Fax:907-796-8710
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2291208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H35620Medicare UPIN
TX8661M1Medicare ID - Type Unspecified