Provider Demographics
NPI:1942350335
Name:THURMOND, ROGER DEAN (MD,PC)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:DEAN
Last Name:THURMOND
Suffix:
Gender:M
Credentials:MD,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71720
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99707-1720
Mailing Address - Country:US
Mailing Address - Phone:907-456-8899
Mailing Address - Fax:907-456-8806
Practice Address - Street 1:4001 GEIST RD
Practice Address - Street 2:SUITE 8
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-3552
Practice Address - Country:US
Practice Address - Phone:907-456-8899
Practice Address - Fax:907-456-8806
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2349174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD2349Medicaid
AKMD2349Medicaid
AKOOOOBJBPQMedicare ID - Type Unspecified