Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 3944 | AK |
NPI | 1003893611 |
---|---|
Provider Name | Dr. Jerry Z Ainsworth |
First Address | Sitka, AK 99835-9416 |
Second Address | Sitka, AK 99835-9416 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/12/2005 |
Last Update Date | 30/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C96818 | (02) | AK |