Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 3857 | AK |
NPI | 1043292865 |
---|---|
Provider Name | Geronimo Sahagun |
First Address | Anchorage, AK 99508-2932 |
Second Address | Anchorage, AK 99508-2932 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2005 |
Last Update Date | 25/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F15121 | (02) | |
MD38571 | (05) | AK |