Provider Demographics
NPI:1144329145
Name:HEALY, RONALD (MD)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:
Last Name:HEALY
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 1:4300 B ST
Mailing Address - Street 2:STE 200
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-5933
Mailing Address - Country:US
Mailing Address - Phone:907-375-3355
Mailing Address - Fax:907-375-3355
Practice Address - Street 1:4300 B ST STE 200
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-5933
Practice Address - Country:US
Practice Address - Phone:907-375-3355
Practice Address - Fax:907-375-3355
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5676207Q00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD2934Medicaid
AKG34880Medicare UPIN
AKP00249576Medicare PIN
AK160298Medicare PIN