Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | 1275 | AK |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 1275 | AK |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 1275 | AK |
NPI | 1992778401 |
---|---|
Provider Name | Dr. Dwight M Ellerbe |
First Address | Anchorage, AK 99508 |
Second Address | Anchorage, AK 99508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2006 |
Last Update Date | 26/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F89005 | (02) | AK |
MD12751 | (05) | AK |