Provider Demographics
NPI:1336300383
Name:LUNDEBYE, JOHAN MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHAN
Middle Name:MARTIN
Last Name:LUNDEBYE
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 1:3801 LAKE OTIS PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5234
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12350 INDUSTRY WAY STE 160
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-4300
Practice Address - Country:US
Practice Address - Phone:907-345-4343
Practice Address - Fax:907-433-5110
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD039860207R00000X
AK8263207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine