Provider Demographics
NPI:1245388099
Name:ODLAND, DUANE I (DO)
Entity type:Individual
Prefix:DR
First Name:DUANE
Middle Name:I
Last Name:ODLAND
Suffix:
Gender:M
Credentials:DO
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 876364
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687
Mailing Address - Country:US
Mailing Address - Phone:907-373-2909
Mailing Address - Fax:907-373-0117
Practice Address - Street 1:950 EAST BOGARD
Practice Address - Street 2:SUITE 234
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:907-373-0850
Practice Address - Fax:907-373-0117
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA1574207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD1574Medicaid
C96843Medicare UPIN
AKMD1574Medicaid