Provider Demographics
NPI:1609808948
Name:ALASKA CENTER FOR DERMATOLOGY, P.C.
Entity Type:Organization
Organization Name:ALASKA CENTER FOR DERMATOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:EHRNSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-646-8500
Mailing Address - Street 1:3841 PIPER STREET
Mailing Address - Street 2:SUITE T4-020
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508
Mailing Address - Country:US
Mailing Address - Phone:907-646-8500
Mailing Address - Fax:907-646-9760
Practice Address - Street 1:3841 PIPER STREET
Practice Address - Street 2:SUITE T4-020
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-646-8500
Practice Address - Fax:907-646-9760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKK152452Medicare ID - Type Unspecified