Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 1473 | AK |
NPI | 1003846197 |
---|---|
Provider Name | V Malurkar Anthes |
First Address | Ketchikan, AK 99901-5635 |
Second Address | Ketchikan, AK 99901-5635 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 07/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1473 | LICENSE (01) | AK |
F58211 | (02) | AK |
MD14731 | (05) | AK |