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Contact Information

JEROME O LIST, D.D.S., M.D.
12641 OLD GLENN HWY STE 201
EAGLE RIVER, AK99577-7040
 Phone: 907-561-1421
 Fax: 907-561-0327
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Otolaryngology

207Y00000X 04 Physician/Otolaryngology
Indicates primary specialty

NPI Profile & details for JEROME O LIST · (Male)

NPI # 1093776080
Status Active
Credentials D.D.S., M.D.
Entity Individual
Enumeration date 03/29/2006
Last updated 04/30/2024 - About 2 years ago
Sole proprietor 1 No
Identifiers
  • AK License # 2607
  • NY License # 329599
  • AK Medicaid MD1123
Hospital affiliation(s)
  • ALASKA REGIONAL HOSPITAL - (Acute Care)
    2801 DEBARR ROAD
    ANCHORAGE, AK 99508
  • PROVIDENCE ALASKA MEDICAL CENTER - (Acute Care)
    BOX 196604
    ANCHORAGE, AK 99508
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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