Provider Demographics
NPI:1932324605
Name:PETER D MARBARGER MD APC
Entity Type:Organization
Organization Name:PETER D MARBARGER MD APC
Other - Org Name:PETER D MARBARGER MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:D
Authorized Official - Last Name:MARBARGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-561-4363
Mailing Address - Street 1:2741 DEBARR RD
Mailing Address - Street 2:SUITE C 402
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2953
Mailing Address - Country:US
Mailing Address - Phone:907-561-4363
Mailing Address - Fax:
Practice Address - Street 1:2741 DEBARR RD
Practice Address - Street 2:SUITE C 402
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2953
Practice Address - Country:US
Practice Address - Phone:907-561-4363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA1750208600000X, 2086S0127X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD1750Medicaid
AKAA1750OtherSTATE LICENSE
AKMD1750Medicaid
AKAA1750OtherSTATE LICENSE