Provider Demographics
NPI:1710910914
Name:BASKOUS, ALEXANDER THOMAS (MD MPH)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:THOMAS
Last Name:BASKOUS
Suffix:
Gender:M
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2841 DEBARR #24
Mailing Address - Street 2:SUITE #24
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2945
Mailing Address - Country:US
Mailing Address - Phone:907-279-4953
Mailing Address - Fax:907-334-9667
Practice Address - Street 1:2841 DEBARR #24
Practice Address - Street 2:SUITE 24
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2945
Practice Address - Country:US
Practice Address - Phone:907-279-4953
Practice Address - Fax:907-334-9667
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1073207Q00000X, 2083X0100X, 207RB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKC96994Medicare UPIN