02D2167469 CLIA NUMBER - ALASKA FAMILY DERMATOLOGY, LLC

Laboratory Demographics

CLIA Number: 02D2167469

Facility Name: ALASKA FAMILY DERMATOLOGY, LLC

Facility Address:
3340 PROVIDENCE DRIVE, STE A358
ANCHORAGE, AK
ZIP 99508
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Facility Phone Number: 907 268-2067

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1265096010

Taxonomy: 207NP0225X - Dermatology
A pediatric dermatologist has, through additional special training, developed expertise in the treatment of specific skin disease categories with emphasis on those diseases which predominate in infants, children and adolescents.

CLIA Record

Field Name	Field Value
CLIA Number	02D2167469
LAB Type	Physician Office
Facility Name	ALASKA FAMILY DERMATOLOGY, LLC
Street	3340 PROVIDENCE DRIVE, STE A358
City	ANCHORAGE
State	AK
ZIP	99508
Phone	907 268-2067
CertificateType	3
CertificateEffectiveDate	6/10/2023
CertificateExpirationDate	6/9/2025
FacilityType	PPMP

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This page was last updated on: 4/23/2024