Provider Demographics
NPI:1063472611
Name:CONGDON, JEFFREY CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:CHARLES
Last Name:CONGDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1729 W 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-4205
Mailing Address - Country:US
Mailing Address - Phone:907-257-4869
Mailing Address - Fax:
Practice Address - Street 1:2925 DEBARR RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2983
Practice Address - Country:US
Practice Address - Phone:907-257-4869
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209304208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery