Provider Demographics
NPI:1679637011
Name:URSEL, BRENT ALAN (PAC)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:ALAN
Last Name:URSEL
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11724 SEWARD HWY
Mailing Address - Street 2:STE D
Mailing Address - City:SEWARD
Mailing Address - State:AK
Mailing Address - Zip Code:99664-9714
Mailing Address - Country:US
Mailing Address - Phone:907-224-8733
Mailing Address - Fax:907-224-8734
Practice Address - Street 1:11724 SEWARD HWY
Practice Address - Street 2:STE D
Practice Address - City:SEWARD
Practice Address - State:AK
Practice Address - Zip Code:99664-9714
Practice Address - Country:US
Practice Address - Phone:907-224-8733
Practice Address - Fax:907-224-8734
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPA202363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK043650384OtherOTHER PAR & NONPAR PAYERS
AKBCBSOther043650384
AK043650384OtherPREMARA
AKMD22813Medicaid
AK043650384OtherNORTHWEST NPI SERVICES
AKBCBSOther043650384
AKP31120Medicare UPIN