Provider Demographics
NPI:1194918367
Name:DAVID M. WITHAM MD INC
Entity type:Organization
Organization Name:DAVID M. WITHAM MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:WITHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-452-5527
Mailing Address - Street 1:1411 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-5902
Mailing Address - Country:US
Mailing Address - Phone:907-457-4900
Mailing Address - Fax:907-457-4913
Practice Address - Street 1:1411 19TH AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5902
Practice Address - Country:US
Practice Address - Phone:907-457-4900
Practice Address - Fax:907-457-4913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4607261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1457328197OtherPERSONAL NPI
1457328197OtherPERSONAL NPI