Basic Information
| Provider Information | |||||||||
| NPI: | 1831271477 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MAGRUDER | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4800 CORDOVA STREET, SUITE 100 | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073753355 | ||||||||
| FaxNumber: | 9073753351 | ||||||||
| Practice Location | |||||||||
| Address1: | 4300 B ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995035933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9073753355 | ||||||||
| FaxNumber: | 9073753351 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2006 | ||||||||
| LastUpdateDate: | 12/27/2017 | ||||||||
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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 | 207Q00000X | 5529 | AK | N | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | 5529 | AK | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.