1518956523 NPI number — DR. CHRISTIANE M SANBURN M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518956523 NPI number — DR. CHRISTIANE M SANBURN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANBURN
Provider First Name:
CHRISTIANE
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
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:
1518956523
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5055 E BROADWAY BLVD STE A100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85711-3629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-382-1205
Provider Business Mailing Address Fax Number:
520-795-0225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1866 E INNOVATION PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORO VALLEY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85755-1963
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-825-2520
Provider Business Practice Location Address Fax Number:
520-825-2501
Provider Enumeration Date:
10/21/2005

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: 207Q00000X , with the licence number:  CS085188 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: MD2010-0685 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 49418 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0808301092 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4749008 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 947002 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 141170 . This is a "PREF CHOICE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: CD3061 . This is a "GROUP RR" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 080H310370 . This is a "GROUP BCBS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0N27000 . This is a "GROUP MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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