Provider Demographics
NPI:1023122991
Name:TAMAI, JIMMY M (MD)
Entity type:Individual
Prefix:
First Name:JIMMY
Middle Name:M
Last Name:TAMAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 71179
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99707-1179
Mailing Address - Country:US
Mailing Address - Phone:907-374-4463
Mailing Address - Fax:907-374-7072
Practice Address - Street 1:1275 SADLER WAY
Practice Address - Street 2:STE 101
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-3175
Practice Address - Country:US
Practice Address - Phone:907-374-4463
Practice Address - Fax:907-374-7072
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AKAK3104207X00000X
AK3104207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD31042Medicaid
AKMDG049Medicaid
AKMD31041Medicaid
AKF82382Medicare UPIN
AK160281Medicare PIN