Provider Demographics
NPI:1861617284
Name:DAHLSTROM, RALPH (MD)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:
Last Name:DAHLSTROM
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 1:542 W 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-2208
Mailing Address - Country:US
Mailing Address - Phone:907-276-1617
Mailing Address - Fax:907-264-2687
Practice Address - Street 1:542 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-2208
Practice Address - Country:US
Practice Address - Phone:907-276-1617
Practice Address - Fax:907-264-2687
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM70-30207W00000X
AK6199207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM14052OtherPRESBYTERIAN
NM0725950001OtherPALMETTO MEDICARE GROUP
NM5681OtherLOVELACE
NM180043761OtherRAILROAD MEDICARE
NM6577Medicaid
NM850482482OtherLOVELACE HMO & SALUD
NM850482482-01OtherCIMARRON HMO & SALUD
NM85-0469981-002OtherCIMARRON
NM4201OtherBC-BS
NM14052OtherPRESBYTERIAN