Provider Demographics
NPI:1679627566
Name:ALYESKA SURGERY AND UROLOGY INC
Entity Type:Organization
Organization Name:ALYESKA SURGERY AND UROLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BRENNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:1907-452-7522
Mailing Address - Street 1:1305 21ST AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-6022
Mailing Address - Country:US
Mailing Address - Phone:907-452-7522
Mailing Address - Fax:
Practice Address - Street 1:1305 21ST AVE
Practice Address - Street 2:STE 101
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-6022
Practice Address - Country:US
Practice Address - Phone:907-452-7522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKMD4599208600000X
AKMD4600208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Not Answered208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKK151741Medicare ID - Type Unspecified