1477640944 NPI number — MRS. SANDRA DUNBRASKY M.D.

Table of content: MRS. SANDRA DUNBRASKY M.D. (NPI 1477640944)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477640944 NPI number — MRS. SANDRA DUNBRASKY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUNBRASKY
Provider First Name:
SANDRA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477640944
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1219 SW 4TH AVE
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
ONTARIO
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-889-2668
Provider Business Mailing Address Fax Number:
541-889-2997

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1219 SW 4TH AVE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
ONTARIO
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-889-2668
Provider Business Practice Location Address Fax Number:
541-889-2997
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  MD17772 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 048962 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000010005327 . This is a "BLUE SHIELD OF ID" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 055336002 . This is a "BLUE CROSS OF OREGON" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 1040301 . This is a "PACIFIC SOURCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 003424800 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".




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