Basic Information
| Provider Information | |||||||||
| NPI: | 1518956523 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANBURN | ||||||||
| FirstName: | CHRISTIANE | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5055 E BROADWAY BLVD STE A100 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857113629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203821205 | ||||||||
| FaxNumber: | 5207950225 | ||||||||
| Practice Location | |||||||||
| Address1: | 1866 E INNOVATION PARK DR | ||||||||
| Address2: | |||||||||
| City: | ORO VALLEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857551963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208252520 | ||||||||
| FaxNumber: | 5208252501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2005 | ||||||||
| LastUpdateDate: | 06/11/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | CS085188 | MI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD2010-0685 | NM | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 49418 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0808301092 | 01 | MI | BCBS | OTHER | 4749008 | 05 | MI | MEDICAID | 947002 | 05 | AZ | MEDICAID | 141170 | 01 | MI | PREF CHOICE | OTHER | CD3061 | 01 | MI | GROUP RR | OTHER | 080H310370 | 01 | MA | GROUP BCBS | OTHER | 0N27000 | 01 | MA | GROUP MEDICARE | OTHER |