Provider Demographics
NPI:1396966040
Name:MALAN, JEDIDIAH JONAH (MD)
Entity type:Individual
Prefix:DR
First Name:JEDIDIAH
Middle Name:JONAH
Last Name:MALAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ALASKA RADIOLOGY ASSOCIATES
Mailing Address - Street 2:3650 PIPER ST, STE A
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508
Mailing Address - Country:US
Mailing Address - Phone:316-519-7664
Mailing Address - Fax:
Practice Address - Street 1:815 2ND AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4400
Practice Address - Country:US
Practice Address - Phone:316-519-7664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD602255852085R0202X
KS63472085R0202X
AK63262085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology