Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 2454 | AK |
Y | 2081S0010X | Sports Medicine | 5068 | AK |
Y | 213ES0000X | Sports Medicine | 5068 | AK |
NPI | 1215904156 |
---|---|
Provider Name | Erik Marshall Kussro |
First Address | Anchorage, AK 99508-4672 |
Second Address | Anchorage, AK 99508-4672 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 18/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H78452 | (02) | |
MD4485 | (05) | AK |