Provider Demographics
NPI:1053574293
Name:PTARMIGAN PEDIATRICS LLC
Entity type:Organization
Organization Name:PTARMIGAN PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-357-4543
Mailing Address - Street 1:3543 E MERIDIAN PARK LOOP STE A
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7233
Mailing Address - Country:US
Mailing Address - Phone:907-357-4543
Mailing Address - Fax:907-357-4533
Practice Address - Street 1:3543 E MERIDIAN PARK LOOP STE A
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7233
Practice Address - Country:US
Practice Address - Phone:907-357-4543
Practice Address - Fax:907-357-4533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty