Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 4215 | AK |
NPI | 1013945948 |
---|---|
Provider Name | Daryl M. Mcclendon |
First Address | Anchorage, AK 99508-6905 |
Second Address | Anchorage, AK 99508-6905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 04/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H10049 | (02) | AK |
MD4215 | (05) | AK |