Provider Demographics
NPI:1780733105
Name:MEDLAND, JEFFREY DALE (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:DALE
Last Name:MEDLAND
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 1:2841 DEBARR RD
Mailing Address - Street 2:SUITE 43
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2958
Mailing Address - Country:US
Mailing Address - Phone:907-274-7847
Mailing Address - Fax:907-274-7845
Practice Address - Street 1:2841 DEBARR RD
Practice Address - Street 2:SUITE 43
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2958
Practice Address - Country:US
Practice Address - Phone:907-274-7847
Practice Address - Fax:907-274-7845
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036084627207RE0101X
AK7131207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism