Provider Demographics
NPI:1932558392
Name:DANNHARDT, EVAN (DO)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:
Last Name:DANNHARDT
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 1:3260 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7808
Mailing Address - Country:US
Mailing Address - Phone:907-796-8700
Mailing Address - Fax:907-796-8710
Practice Address - Street 1:3268 HOSPITAL DR STE A
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7800
Practice Address - Country:US
Practice Address - Phone:907-796-8700
Practice Address - Fax:907-796-8710
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1886208600000X
171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery