Eagle River Dermatology Inc

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

AK503 Issued in AK

Legal business name

EAGLE RIVER DERMATOLOGY INC

Practice address

16839 Park Place St
Eagle River, AK 99577

Phone

(907) 694-3303

Fax

(907) 694-4773

NPI assigned

Feb 6, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lindsay Jay Proctor, M.A

Title

Office Manager

Phone

(907) 694-3303

Specialties & licenses 1

Addresses

Other names 1

• EAGLE RIVER DERMATOLOGY INC Doing business as

Medicare fee-for-service enrollment

Enrolled in AK

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Andrzej R Maciejewski, MD

  • Nephrology Physician
  • Anchorage, AK
  • NPI 1194780114

  Dermatology

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1517875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517875200000",
    "number": "1750880654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16839 PARK PLACE ST",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "99577",
            "telephone_number": "907-694-3303",
            "fax_number": "907-694-4773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16839 PARK PLACE ST",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "99577",
            "telephone_number": "907-694-3303",
            "fax_number": "907-694-4773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGLE RIVER DERMATOLOGY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-06",
        "last_updated": "2018-02-06",
        "status": "A",
        "authorized_official_last_name": "PROCTOR",
        "authorized_official_first_name": "LINDSAY",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "907-694-3303",
        "authorized_official_credential": "M.A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "AK",
            "license": "AK503",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EAGLE RIVER DERMATOLOGY INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Elizabeth Claire Dufour, MSCC
• Kathleen Dye, PHARM.D.
• Eagle River Acupuncture LLC.
• Eagle River Behavioral Health
• Eagle River Behavioral Health, LLC
• Eagle River Pain & Wellness, LLC
• Eagle River Primary Care
• Eagle River Therapeutic Massage LLC
• Eagle River Vision Clinic Inc
• Eagle Summit Dental Group

• Dermatology Physician in Eagle River, AK
• Providers in Eagle River, AK by specialty
• Dermatology Physician in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.