Provider Demographics
NPI:1720105034
Name:GREGORY H DOSTAL MD PC
Entity type:Organization
Organization Name:GREGORY H DOSTAL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:DOSTAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-586-3068
Mailing Address - Street 1:3225 HOSPITAL DR
Mailing Address - Street 2:#102
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7863
Mailing Address - Country:US
Mailing Address - Phone:907-586-3068
Mailing Address - Fax:
Practice Address - Street 1:3225 HOSPITAL DR
Practice Address - Street 2:#102
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7863
Practice Address - Country:US
Practice Address - Phone:907-586-3068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty