NPI 1396966040 · live from the CMS NPI Registry
Jedidiah Jonah Malan, MD
Radiology, Diagnostic Radiology in Fairbanks, AK. National Provider Identifier 1396966040, active.
NPI record
| NPI | 1396966040 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Radiology, Diagnostic Radiology 2085R0202X |
| Practice location | 815 2nd Ave, Suite 202, Fairbanks, AK 99701 |
| Practice phone | 316-519-7664 |
| Mailing address | Alaska Radiology Associates, 3650 Piper St, Ste A, Anchorage, AK 99508 |
| Enumerated | May 1, 2007 |
| Last updated | October 7, 2020 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Radiology, Diagnostic Radiology | 2085R0202X | MD60225585 (WA) |
| Radiology, Diagnostic Radiology | 2085R0202X | 6347 (KS) |
| Radiology, Diagnostic Radiology primary | 2085R0202X | 6326 (AK) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.