Provider Demographics
NPI:1023027380
Name:MAY, FREDRICK GEORGE (PA-C)
Entity type:Individual
Prefix:
First Name:FREDRICK
Middle Name:GEORGE
Last Name:MAY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19807 1ST ST
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8432
Mailing Address - Country:US
Mailing Address - Phone:907-696-5246
Mailing Address - Fax:
Practice Address - Street 1:11432 BUSINESS BLVD
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7720
Practice Address - Country:US
Practice Address - Phone:907-694-1300
Practice Address - Fax:907-694-1315
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK361363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant