| Doctor Name: | DR. IVAN S ANKENBRANDT |
| NPI Number: | 1467722421 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | AFE16472 |
| Business Practice Address: | 3055 Bridger Rd. Wilson, WY - 83014 |
| Business Phone Number: | 3077339177 |
| Business Fax Number: | |
| Mailing Address: | Po Box 311, TETON VILLAGE |
| State: | WY |
| Postal Code: | 830250311 |
| Phone Number: | 3077339177 |
| Fax Number: | |
| NPI Enumeration Date: | 01/09/2012 |
| NPI Last Update Date: | 01/09/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | AFE16472 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |