Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 2059 | AK |
N | 208000000X | Pediatrician | 2059 | AK |
NPI | 1033184023 |
---|---|
Provider Name | Dr. James Timothy Foote |
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 | 22/02/2006 |
Last Update Date | 21/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1020064 | (05) | AK |
AF2645375 | DEA NUMBER (01) | |
C96873 | (02) | AK |