Provider Demographics
NPI:1821159674
Name:THORNQUIST, ROBERT K (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:K
Last Name:THORNQUIST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3650 LAKE OTIS PKWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5207
Mailing Address - Country:US
Mailing Address - Phone:907-561-3836
Mailing Address - Fax:907-561-3858
Practice Address - Street 1:3650 LAKE OTIS PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5207
Practice Address - Country:US
Practice Address - Phone:907-561-3836
Practice Address - Fax:907-561-3858
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AKAA2198207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD9899Medicaid
AKK0000BKSBNMedicare ID - Type Unspecified
AKMD9899Medicaid