Basic Information
| Provider Information | |||||||||
| NPI: | 1477621597 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | EDWARD | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 E DIMOND BLVD | ||||||||
| Address2: | #12 | ||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995151908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073417757 | ||||||||
| FaxNumber: | 9073417760 | ||||||||
| Practice Location | |||||||||
| Address1: | 1700 E PARKS HWY | ||||||||
| Address2: | #200 | ||||||||
| City: | WASILLA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996547352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073736055 | ||||||||
| FaxNumber: | 9073736077 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 340 | AK | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.