Provider Demographics
NPI:1649362948
Name:JUNEAU OBSTETRICS AND GYNECOLOGY, P.C.
Entity type:Organization
Organization Name:JUNEAU OBSTETRICS AND GYNECOLOGY, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:D
Authorized Official - Last Name:NEWBURY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:907-586-1717
Mailing Address - Street 1:3268 HOSPITAL DR STE B
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7800
Mailing Address - Country:US
Mailing Address - Phone:907-586-1717
Mailing Address - Fax:907-586-2677
Practice Address - Street 1:3268 HOSPITAL DR STE B
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7800
Practice Address - Country:US
Practice Address - Phone:907-586-1717
Practice Address - Fax:907-586-2677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2017-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2531207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1020712Medicaid
AKMD2531Medicaid
AKD37792Medicare UPIN
AK152091Medicare ID - Type Unspecified