Provider Demographics
NPI:1427251008
Name:EVERETT, JOHN JAY (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:JAY
Last Name:EVERETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10900 STONY BROOK DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-1862
Mailing Address - Country:US
Mailing Address - Phone:206-753-7225
Mailing Address - Fax:
Practice Address - Street 1:4315 DIPLOMACY DRIVE/EMERGENCY DEPT
Practice Address - Street 2:ALASKA NATIVE MEDICAL CENTER
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2511
Practice Address - Country:US
Practice Address - Phone:206-753-7225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-09
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK7561207P00000X
NE24331207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1616419Medicaid
AKK167520Medicare PIN
AK1616419Medicaid
AKK166418Medicare PIN