Provider Demographics
NPI:1538159165
Name:ANDERSON, JANICE M (MD)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3427 E TUDOR RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1282
Mailing Address - Country:US
Mailing Address - Phone:907-563-3679
Mailing Address - Fax:907-565-8066
Practice Address - Street 1:3440 PROVIDENCE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-261-3148
Practice Address - Fax:907-565-8066
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK15222085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD1522Medicaid
AKK00WCGQLAMedicare ID - Type Unspecified
C96851Medicare UPIN