Basic Information
| Provider Information | |||||||||
| NPI: | 1497713572 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALIS | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 130 | ||||||||
| Address2: | 6000 KANAKANAK RD | ||||||||
| City: | DILLINGHAM | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9078425201 | ||||||||
| FaxNumber: | 9078429250 | ||||||||
| Practice Location | |||||||||
| Address1: | 6000 KANAKANAK RD | ||||||||
| Address2: | |||||||||
| City: | DILLINGHAM | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99576 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9078425201 | ||||||||
| FaxNumber: | 9078429250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | X | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4429 | AK | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8EZ604 | 01 | CLARKS POINT | OTHER | 8EZ663 | 01 | KING SALMON | OTHER | 8EZ693 | 01 | MANOKOTAK | OTHER | 8EZ723 | 01 | PERRYVILLE CLINIC | OTHER | 8EZ743 | 01 | PILOT POINT CLINIC | OTHER | 8EZ505 | 01 | N ALEKNAGIK | OTHER | 8EZ534 | 01 | S ALEKNAGIK | OTHER | 8EZ733 | 01 | PORT HEIDEN | OTHER | 8EZ524 | 01 | KANAKANAK | OTHER | 8EZ544 | 01 | CHIG LAGOON | OTHER | 8EZ653 | 01 | IVANOFF BAY | OTHER | 8EZ643 | 01 | IGIUGIG CLINIC | OTHER | 8EZ703 | 01 | NAKNEK CLINIC | OTHER | 8EZ673 | 01 | KOLIGANEK | OTHER | 8EZ713 | 01 | NEW STUYAHOK | OTHER | 8EZ683 | 01 | LEVELOCK CLINIC | OTHER | 8EZ515 | 01 | CHIG LAKE | OTHER | 8EZ623 | 01 | EKWOK CLINIC | OTHER |