Provider Demographics
NPI:1194729731
Name:DEBERARD, SCOTT C (DO)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:C
Last Name:DEBERARD
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:9220 LAKE OTIS PKWY
Mailing Address - Street 2:STE 9
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-4249
Mailing Address - Country:US
Mailing Address - Phone:907-344-0200
Mailing Address - Fax:907-344-0214
Practice Address - Street 1:9220 LAKE OTIS PKWY
Practice Address - Street 2:STE 9
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-4249
Practice Address - Country:US
Practice Address - Phone:907-344-0200
Practice Address - Fax:907-344-0214
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-10
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AKAK 4406207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKAK4406OtherLICENSE