Provider Demographics
NPI:1720262165
Name:KEVIN M TOMERA MD INC
Entity Type:Organization
Organization Name:KEVIN M TOMERA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:TOMERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-276-8529
Mailing Address - Street 1:PO BOX 241889
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99524-1889
Mailing Address - Country:US
Mailing Address - Phone:907-751-8116
Mailing Address - Fax:907-561-7464
Practice Address - Street 1:1200 AIRPORT HEIGHTS DR
Practice Address - Street 2:STE 210
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2943
Practice Address - Country:US
Practice Address - Phone:907-276-8529
Practice Address - Fax:907-274-8529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAK6700892208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKC45891Medicare UPIN