Provider Demographics
NPI:1992814099
Name:ROBERT D. DINGEMAN, MD
Entity type:Organization
Organization Name:ROBERT D. DINGEMAN, MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DENISON
Authorized Official - Last Name:DINGEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-452-2663
Mailing Address - Street 1:751 OLD RICHARDSON HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-7813
Mailing Address - Country:US
Mailing Address - Phone:907-452-2663
Mailing Address - Fax:907-456-3033
Practice Address - Street 1:751 OLD RICHARDSON HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-7813
Practice Address - Country:US
Practice Address - Phone:907-452-2663
Practice Address - Fax:907-456-3033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAK2137261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD9915Medicaid
AKC96865Medicare UPIN
AKMD9915Medicaid