Provider Demographics
NPI:1063441178
Name:SERIE, DENNIS PATRICK (PA)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:PATRICK
Last Name:SERIE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 671764
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-1764
Mailing Address - Country:US
Mailing Address - Phone:907-854-8452
Mailing Address - Fax:907-222-4641
Practice Address - Street 1:22742 OBERG RD
Practice Address - Street 2:
Practice Address - City:CHUGIAK
Practice Address - State:AK
Practice Address - Zip Code:99567-5495
Practice Address - Country:US
Practice Address - Phone:907-854-8452
Practice Address - Fax:907-222-4641
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK633363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMDA0081Medicaid
AKK160650Medicare PIN