Provider Demographics
NPI:1780782847
Name:O'MALLEY, JAMES E (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:O'MALLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 93010
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99509-3010
Mailing Address - Country:US
Mailing Address - Phone:907-360-8582
Mailing Address - Fax:907-868-4064
Practice Address - Street 1:1615 HIDDEN LN
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-4917
Practice Address - Country:US
Practice Address - Phone:907-360-8582
Practice Address - Fax:907-868-4064
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK2209208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD2209Medicaid
AKD43376Medicare UPIN
AKMD2209Medicaid