Provider Demographics
NPI:1982861712
Name:MCCAULEY, ALICE L (MD)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:L
Last Name:MCCAULEY
Suffix:
Gender:F
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:PO BOX 2388
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:AK
Mailing Address - Zip Code:99664-2388
Mailing Address - Country:US
Mailing Address - Phone:509-220-4555
Mailing Address - Fax:
Practice Address - Street 1:7000 UULA ST
Practice Address - Street 2:
Practice Address - City:UTQIAGVIK
Practice Address - State:AK
Practice Address - Zip Code:99723
Practice Address - Country:US
Practice Address - Phone:907-825-9211
Practice Address - Fax:907-825-6222
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKMEDS7353207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMEDS7353OtherMEDICAL LICENSE
AKFM2965498OtherDEA