Basic Information
| Provider Information | |||||||||
| NPI: | 1336114388 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VERMILLION | ||||||||
| FirstName: | DOUG | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2741 DEBARR RD STE C214 | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995082978 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9076446055 | ||||||||
| FaxNumber: | 9076444885 | ||||||||
| Practice Location | |||||||||
| Address1: | 2741 DEBARR RD STE C214 | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995082978 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9076446055 | ||||||||
| FaxNumber: | 9076444885 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2006 | ||||||||
| LastUpdateDate: | 02/11/2008 | ||||||||
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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 | 207X00000X | L4783 | TX | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.