Provider Demographics
NPI:1821225913
Name:DOE, ALTON E JR (IDMT)
Entity Type:Individual
Prefix:MR
First Name:ALTON
Middle Name:E
Last Name:DOE
Suffix:JR
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3349 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:EIELSON AIR FORCE BAS
Mailing Address - State:AK
Mailing Address - Zip Code:99702
Mailing Address - Country:US
Mailing Address - Phone:907-377-4326
Mailing Address - Fax:
Practice Address - Street 1:2630 CENTRAL AVE
Practice Address - Street 2:STE 1
Practice Address - City:EIELSON AFB
Practice Address - State:AK
Practice Address - Zip Code:99702-2301
Practice Address - Country:US
Practice Address - Phone:907-377-4326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians