Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003241985 |
---|---|
Provider Name | John Duncan |
First Address | Fairbanks, AK 99709-5521 |
Second Address | Fairbanks, AK 99709-5521 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2013 |
Last Update Date | 10/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MH3237 | (05) | AK |