Provider Demographics
NPI:1053619098
Name:ALPINE DERMATOLOGY, LLC
Entity type:Organization
Organization Name:ALPINE DERMATOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT CERTIFIED
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PAC
Authorized Official - Phone:907-523-5411
Mailing Address - Street 1:3225 HOSPITAL DR UNIT 101A
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7863
Mailing Address - Country:US
Mailing Address - Phone:907-523-5411
Mailing Address - Fax:907-523-9884
Practice Address - Street 1:3268 HOSPITAL DR STE A
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7800
Practice Address - Country:US
Practice Address - Phone:907-523-5411
Practice Address - Fax:907-523-9884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-28
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK944363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty