Provider Demographics
NPI:1922389287
Name:JOHN B DEKEYSER MD PC
Entity Type:Organization
Organization Name:JOHN B DEKEYSER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BAPTIST
Authorized Official - Last Name:DEKEYSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-339-9700
Mailing Address - Street 1:1200 AIRPORT HEIGHTS DR
Mailing Address - Street 2:SUITE 280
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2965
Mailing Address - Country:US
Mailing Address - Phone:907-339-9700
Mailing Address - Fax:907-339-9721
Practice Address - Street 1:1200 AIRPORT HEIGHTS DR
Practice Address - Street 2:SUITE 280
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2965
Practice Address - Country:US
Practice Address - Phone:907-339-9700
Practice Address - Fax:907-339-9721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-31
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2087207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD9942Medicaid
AKC97051Medicare UPIN
AKMD9942Medicaid