Alaska Family Dermatology, LLC
Organization Active NPI Pediatric Dermatology Physician · Anchorage, AK
NPI 1265096010 · NPPES record last updated Apr 18, 2025
Key facts
- NPI
- 1265096010
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatric Dermatology Physician 207NP0225X
- Legal business name
- ALASKA FAMILY DERMATOLOGY, LLC
- Practice address
- 3340 Providence Dr Ste A358
Anchorage, AK 99508-4691 - Phone
- (907) 268-2067
- Fax
- (855) 395-0858
- NPI assigned
- Apr 26, 2019
- Organization subpart
- No
Authorized official
- Name
- Mrs. Gina Marie Brown, MD
- Title
- Owner/Dermatologist
- Phone
- (907) 268-2067
Practitioners 2
-
Gina M Brown, M.D.
-
Elizabeth Ashley Taylor, PA-C, ATC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 02D2167469 | Alaska Family Dermatology, LLC | Provider-performed microscopy | Jun 9, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190610003059 | AK | Part B Supplier - Clinic/Group Practice | 7719210590 |
Receives reassigned benefits from 2 practitioners Practice locations: Anchorage, AK |
National Provider Directory
Locations
3340 Providence Dr
Ste 358
Anchorage, AK 99508
Phone (907) 261-2880
3340 Providence Dr
Ste 358A
Anchorage, AK 99508
Phone (907) 268-2067
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dermatology Physician |
207NP0225X | Yes |
Addresses
Primary practice location
3340 Providence Dr Ste A358
Anchorage, AK 99508-4691
Mailing address
3340 Providence Dr Ste 358
Anchorage, AK 99508-4627
Phone (907) 268-2067
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1583538 | Medicaid | AK |
Other providers in Anchorage, AK
- Alaska Eye Surgery and Laser Center, Inc.
- Alaska Eyecare Professionals LLC
- Alaska Family Care Associates, LLC
- Alaska Family Counseling, LLC
- Alaska Family Dental LLC
- Alaska Family Medical Care LLC
- Alaska Family Sonograms, Inc
- Alaska Family Wellness Center Inc
- Alaska Family Women'S H.O.P. Housing Service, Inc
- Alaska First Assist'S LLC
All providers in Anchorage, AK · Pediatric Dermatology Physician in Alaska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 18, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.