=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679025811
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANNA LAMBERTSON, MD, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2016
-----------------------------------------------------
Last Update Date | 11/03/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 CRATER LAKE AVE SUITE 5
-----------------------------------------------------
City | MEDFORD
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97504-7445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-499-6026
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 CRATER LAKE AVE SUITE 5
-----------------------------------------------------
City | MEDFORD
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97504-7445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-499-6026
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ANNA LAMBERTSON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 541-499-6026
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2083P0901X
-----------------------------------------------------
Taxonomy Name | Public Health & General Preventive Medicine Physician
-----------------------------------------------------
License Number | MD168559
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------