Provider Demographics
NPI:1619955606
Name:ANZILOTTI, JOSE PRIMO N (MD)
Entity Type:Individual
Prefix:
First Name:JOSE PRIMO
Middle Name:N
Last Name:ANZILOTTI
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:PO BOX 241769
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99524-1769
Mailing Address - Country:US
Mailing Address - Phone:907-770-2380
Mailing Address - Fax:907-770-2390
Practice Address - Street 1:PARKS HIGHWAY MILE 69.1
Practice Address - Street 2:
Practice Address - City:WILLOW
Practice Address - State:AK
Practice Address - Zip Code:99688
Practice Address - Country:US
Practice Address - Phone:907-495-4362
Practice Address - Fax:907-495-4363
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4141208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD3671Medicaid
AK151589Medicare ID - Type Unspecified
AKMD3671Medicaid