Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 4038 | AK |
NPI | 1003863671 |
---|---|
Provider Name | Candace L Clawson |
First Address | Anchorage, AK 99508-5926 |
Second Address | Anchorage, AK 99508-5926 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2006 |
Last Update Date | 24/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H55127 | (02) | AK |
MD0675 | (05) | AK |