Provider Demographics
NPI:1649236084
Name:DEMERS, MARY PATRICIA (DO)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:PATRICIA
Last Name:DEMERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 PROVIDENCE DR
Mailing Address - Street 2:STE 466
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4616
Mailing Address - Country:US
Mailing Address - Phone:907-263-2200
Mailing Address - Fax:907-276-0366
Practice Address - Street 1:3340 PROVIDENCE DR
Practice Address - Street 2:STE 466
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4616
Practice Address - Country:US
Practice Address - Phone:907-263-2200
Practice Address - Fax:907-276-0366
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA3359207R00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD2204Medicaid
AKMD2204Medicaid
C96839Medicare UPIN