Provider Demographics
NPI:1356437792
Name:FAIRBANKS RADIATION ONCOLOGY LLC
Entity type:Organization
Organization Name:FAIRBANKS RADIATION ONCOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:L
Authorized Official - Middle Name:RODNEY
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-261-3186
Mailing Address - Street 1:PO BOX 232069
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99523-2069
Mailing Address - Country:US
Mailing Address - Phone:907-458-5380
Mailing Address - Fax:907-743-2641
Practice Address - Street 1:1650 COWLES STREET
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701
Practice Address - Country:US
Practice Address - Phone:907-458-5380
Practice Address - Fax:907-743-2640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK151187Medicare ID - Type Unspecified