Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | MEDO5553 | AK |
N | 207Q00000X | Family Doctor | 5553 | AK |
Y | 207Q00000X | Family Doctor | MEDO5553 | AK |
N | 207QA0401X | Family Doctor - Addiction Medicine | MEDO5553 | AK |
NPI | 1609841006 |
---|---|
Provider Name | Dr. Herbert Day |
First Address | Fairbanks, AK 99701-4922 |
Second Address | Fairbanks, AK 99701-4922 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2006 |
Last Update Date | 09/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1017015 | (05) | AK |
BD9290660 | DEA NUMBER (01) | |
H06710 | (02) | AK |