Basic Information
| Provider Information | |||||||||
| NPI: | 1194882282 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SEMANCIK | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4120 LAUREL ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995085392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077436944 | ||||||||
| FaxNumber: | 9077430694 | ||||||||
| Practice Location | |||||||||
| Address1: | 4120 LAUREL ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995085392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077436944 | ||||||||
| FaxNumber: | 9077430694 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2007 | ||||||||
| LastUpdateDate: | 03/18/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0206X | 7076 | AK | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | MD9892 | 05 | AK | MEDICAID |