Provider Demographics
NPI:1306917562
Name:COURTNAGE, PETER A (DAC, PSYD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:A
Last Name:COURTNAGE
Suffix:
Gender:M
Credentials:DAC, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 K ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-3329
Mailing Address - Country:US
Mailing Address - Phone:907-243-3031
Mailing Address - Fax:907-243-3922
Practice Address - Street 1:626 K ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3329
Practice Address - Country:US
Practice Address - Phone:907-243-3031
Practice Address - Fax:907-243-3922
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK401103TC0700X
AK003171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK160314Medicare UPIN