Provider Demographics
NPI:1366549032
Name:SIDDALL, JAMES J (PA-C)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:SIDDALL
Suffix:
Gender:M
Credentials:PA-C
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 70851
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99707-0851
Mailing Address - Country:US
Mailing Address - Phone:907-585-6415
Mailing Address - Fax:907-585-6244
Practice Address - Street 1:200 A ST
Practice Address - Street 2:CLEAR AFS
Practice Address - City:CLEAR
Practice Address - State:AK
Practice Address - Zip Code:99704-5360
Practice Address - Country:US
Practice Address - Phone:907-585-6415
Practice Address - Fax:907-585-6244
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK036363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical