Provider Demographics
NPI:1528034733
Name:BUNDTZEN, ROBERT W (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:W
Last Name:BUNDTZEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4120 LAUREL STREET
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508
Mailing Address - Country:US
Mailing Address - Phone:907-561-4362
Mailing Address - Fax:907-563-4498
Practice Address - Street 1:4120 LAUREL STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-561-4362
Practice Address - Fax:907-563-4498
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AKMD2056207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD2056Medicaid
AKMD2056Medicaid
C97018Medicare UPIN