Provider Demographics
NPI:1366421885
Name:LIMSTROM, SCOTT A (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:LIMSTROM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3500 LA TOUCHE
Mailing Address - Street 2:STE 250
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4261
Mailing Address - Country:US
Mailing Address - Phone:907-561-1530
Mailing Address - Fax:907-561-2611
Practice Address - Street 1:3500 LA TOUCHE
Practice Address - Street 2:STE 250
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4261
Practice Address - Country:US
Practice Address - Phone:907-561-1530
Practice Address - Fax:907-561-2611
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK3741207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD1143Medicaid
AK152662Medicare ID - Type Unspecified
AKMD1143Medicaid