List, Jerome O

List, Jerome O is an individual health care provider with primary practice located at 12641 Old Glenn Hwy Ste 201 , Eagle River AK 99577-7040. He recently has only one registered license in Allopathic & Osteopathic Physicians / Otolaryngology, which is considered as his primary health care specialty. List, Jerome O can be contacted via phone (907) 561-1421.

Contact Information

Primary practice address
12641 Old Glenn Hwy Ste 201 Eagle River AK 99577-7040
Phone: (907) 561-1421
Fax: (907) 561-0327
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Otolaryngology 207Y00000X 329599 New York
Allopathic & Osteopathic Physicians / Otolaryngology 207Y00000X 2607 Alaska

Profile Details

NPI number 1093776080
LBN Legal business name List, Jerome O
Credentials D.D.S., M.D.
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 29th, 2006
Last updated Apr 30th, 2024 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1093776080 NPPES
Alaska MEDICAID MD1123

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