Provider Demographics
NPI:1104068378
Name:SOUTHEAST PSYCHIATRY
Entity type:Organization
Organization Name:SOUTHEAST PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:JIRI
Authorized Official - Last Name:TOPOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-209-8962
Mailing Address - Street 1:301 3RD ST
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-1204
Mailing Address - Country:US
Mailing Address - Phone:907-209-8962
Mailing Address - Fax:
Practice Address - Street 1:301 3RD ST
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1204
Practice Address - Country:US
Practice Address - Phone:907-209-8962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-02
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK59602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty