Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 5240 | AK |
NPI | 1942272059 |
---|---|
Provider Name | Dr. Jack Donovan Sedwick II |
First Address | Anchorage, AK 99520-1875 |
Second Address | Anchorage, AK 99508-5445 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 29/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MD2745 | (05) | AK |