Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 5255 | AK |
NPI | 1184702102 |
---|---|
Provider Name | Dr. Myron Fribush |
First Address | Sitka, AK 99835-7142 |
Second Address | Sitka, AK 99835-7142 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 15/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B81961 | (02) | |
MD4646 | (05) | AK |