Provider Demographics
NPI:1508809534
Name:STANBERRY, CARL (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:STANBERRY
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 1:188 W NORTHERN LIGHTS BLVD, SUITE 800
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503
Mailing Address - Country:US
Mailing Address - Phone:907-276-2803
Mailing Address - Fax:907-276-8052
Practice Address - Street 1:188 W NORTHERN LIGHTS BLVD, SUITE 800
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503
Practice Address - Country:US
Practice Address - Phone:907-276-2803
Practice Address - Fax:907-276-8052
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD15397207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3006337Medicaid
TN4012694OtherBCBS
TN050079788OtherRAILROAD MEDICARE
KY64929581OtherKY MEDICAID
TN4012694OtherBCBS
TN3006337Medicaid