Provider Demographics
NPI:1194987511
Name:PAISLEY, KEVIN CHARLES (DO)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:CHARLES
Last Name:PAISLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 M ST APT 402
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-1902
Mailing Address - Country:US
Mailing Address - Phone:954-591-3636
Mailing Address - Fax:954-591-3636
Practice Address - Street 1:4015 LAKE OTIS PKWY STE 201
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5235
Practice Address - Country:US
Practice Address - Phone:907-771-3500
Practice Address - Fax:907-771-3550
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008016558207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2008016558OtherMEDICAL LICENSE
AK1617926Medicaid
AK8162OtherALASKA LICENSE