Provider Demographics
NPI:1922123843
Name:MUFFOLETTO, JOHN P (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:MUFFOLETTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2751 DEBARR RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2953
Mailing Address - Country:US
Mailing Address - Phone:907-276-1046
Mailing Address - Fax:907-222-6898
Practice Address - Street 1:2751 DEBARR RD
Practice Address - Street 2:SUITE 290
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2953
Practice Address - Country:US
Practice Address - Phone:907-276-1046
Practice Address - Fax:907-222-6898
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK3873208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD3873Medicaid
AKK161072Medicare PIN
AKF77435Medicare UPIN