Provider Demographics
NPI:1053577544
Name:JONES, GLEN A (PAC)
Entity type:Individual
Prefix:MR
First Name:GLEN
Middle Name:A
Last Name:JONES
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1700 E PARKS HWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7352
Mailing Address - Country:US
Mailing Address - Phone:907-373-6055
Mailing Address - Fax:907-373-6077
Practice Address - Street 1:1700 E PARKS HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7352
Practice Address - Country:US
Practice Address - Phone:907-373-6055
Practice Address - Fax:907-373-6077
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK303363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK303OtherALASKA STATE LICENSE NUMBER