Basic Information
| Provider Information | |||||||||
| NPI: | 1396895272 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARBARGER | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MARBARGER | ||||||||
| OtherFirstName: | PETER | ||||||||
| OtherMiddleName: | D | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 200149 | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995200149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075613211 | ||||||||
| FaxNumber: | 9075627547 | ||||||||
| Practice Location | |||||||||
| Address1: | 3841 PIPER ST | ||||||||
| Address2: | SUITE T-100 | ||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995084624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075613211 | ||||||||
| FaxNumber: | 9075627547 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2007 | ||||||||
| LastUpdateDate: | 03/25/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 1750 | AK | Y | Allopathic & Osteopathic Physicians | Surgery | 2086S0127X | 1750 | AK | N | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | 2086S0129X | 1750 | AK | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | AA1750 | 01 | AK | MEDICAL LICENSE | OTHER | 1010675 | 05 | AK | MEDICAID |