Provider Demographics
NPI:1629077938
Name:HANLEY, OWEN QUIGLEY (MD)
Entity Type:Individual
Prefix:
First Name:OWEN
Middle Name:QUIGLEY
Last Name:HANLEY
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 71659
Mailing Address - Street 2:CHEST MEDICINE FAIRBANKS, PC
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99707-1659
Mailing Address - Country:US
Mailing Address - Phone:907-456-3750
Mailing Address - Fax:907-451-1701
Practice Address - Street 1:1650 COWLES ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5998
Practice Address - Country:US
Practice Address - Phone:907-458-5680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA1350207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C97103Medicare UPIN
150420Medicare ID - Type Unspecified
AKMD1350Medicare ID - Type Unspecified