Medical school: LOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN SHREVEPORT
Graduated: 1982
NPI: 1053383711
Practice Locations (3)
1212 10TH AVE
FAIRBANKS, AK 997014113
9074744745
PO BOX, SUITE 72283
FAIRBANKS, AK 99707
PO BOX, SUITE 82815
FAIRBANKS, AK 99708
Source: CMS National Downloadable File, September 2026.