Healthcare Provider Details

I. General information

NPI: 1750401998
Provider Name (Legal Business Name): ANYA ELIZABETH BANDT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANYA E LANDECK M.D.

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2924 SISKIYOU BLVD STE 200
MEDFORD OR
97504-6462
US

IV. Provider business mailing address

1310 COMMERCE ST STE B
PETALUMA CA
94954-1469
US

V. Phone/Fax

Practice location:
  • Phone: 541-200-2777
  • Fax: 541-214-2575
Mailing address:
  • Phone: 707-778-7862
  • Fax: 707-778-0969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD231168
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberMD231168
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA65186
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberA65186
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA65186
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: