Provider Demographics
NPI:1538361522
Name:OK, TAE DUK (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:TAE
Middle Name:DUK
Last Name:OK
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 283
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL ISLAND
Mailing Address - State:AK
Mailing Address - Zip Code:99660-0283
Mailing Address - Country:US
Mailing Address - Phone:907-546-8300
Mailing Address - Fax:
Practice Address - Street 1:800 CORDOVA ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3717
Practice Address - Country:US
Practice Address - Phone:907-222-7612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK541363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant