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NPI Code Detail

MEDICARE: DR. ANYA ELIZABETH BANDT M.D.

MEDICARE: DR. ANYA ELIZABETH BANDT M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology PhysicianMD231168OR
2207ND0101XMOHS-Micrographic Surgery PhysicianMD231168OR
3207ND0101XMOHS-Micrographic Surgery PhysicianA65186CA
4207NS0135XProcedural Dermatology PhysicianA65186CA
5207N00000XDermatology PhysicianA65186CA

General Provider Information

NPI Number : 1750401998
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANYA ELIZABETH BANDT M.D.
Provider Business Mailing Address
First Line : 1310 COMMERCE ST STE B
Second Line :
City : PETALUMA
State : CA
Zip : 94954-1469
Country : US
Telephone Number : 707-778-7862
Fax Number : 707-778-0969
Provider Business Practice Location Address
First Line : 2924 SISKIYOU BLVD STE 200
Second Line :
City : MEDFORD
State : OR
Zip : 97504-6462
Country : US
Telephone Number : 541-200-2777
Fax Number : 541-214-2575
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2007
Last Update Date : 06/23/2026

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