| Organization Name: | MEDICAL GROUP OF ALASKA |
| NPI Number: | 1750730594 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WADE STEVEN ERICKSON (OWNER) |
| Mailing Address: | 3122 E Meridian Park Loop Wasilla |
| State: | AK US |
| Postal Code: | 996547255 |
| Phone Number: | 9073579590 |
| Fax Number: | 9073579593 |
| NPI Enumeration Date: | 06/10/2016 |
| NPI Last Update Date: | 06/10/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 1019166 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AK |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |