Provider Demographics
NPI:1811093743
Name:STANDERWICK, ANNE BAKKER (MD)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:BAKKER
Last Name:STANDERWICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:MICHELLE
Other - Last Name:BAKKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:641 W WILLOUGHBY AVE
Mailing Address - Street 2:#201
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801
Mailing Address - Country:US
Mailing Address - Phone:907-586-8100
Mailing Address - Fax:907-586-8102
Practice Address - Street 1:641 W WILLOUGHBY AVE
Practice Address - Street 2:#201
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801
Practice Address - Country:US
Practice Address - Phone:907-586-8100
Practice Address - Fax:907-586-8102
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4033207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD9819Medicaid
G50462Medicare UPIN
AKMD9819Medicaid