Provider Demographics
NPI:1609803089
Name:WONCHALA, DAVID P (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:P
Last Name:WONCHALA
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:3831 PIPER ST
Mailing Address - Street 2:SUITE S-220
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4672
Mailing Address - Country:US
Mailing Address - Phone:907-563-3145
Mailing Address - Fax:907-561-3967
Practice Address - Street 1:3831 PIPER ST
Practice Address - Street 2:SUITE S-220
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4672
Practice Address - Country:US
Practice Address - Phone:907-563-3145
Practice Address - Fax:907-561-3967
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2011-01-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AK1422363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P92933Medicare UPIN
AK160135Medicare PIN