Provider Demographics
NPI:1821256835
Name:MCDERMOTT, WILLIAM JORDAN (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JORDAN
Last Name:MCDERMOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 PROVIDENCE DR
Mailing Address - Street 2:SUITE 207
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4690
Mailing Address - Country:US
Mailing Address - Phone:907-561-0005
Mailing Address - Fax:907-563-9140
Practice Address - Street 1:3300 PROVIDENCE DR
Practice Address - Street 2:SUITE 207
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4690
Practice Address - Country:US
Practice Address - Phone:907-561-0005
Practice Address - Fax:907-563-9140
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AK7354207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program