Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 4301039821 | MI |
NPI | 1003897323 |
---|---|
Provider Name | Dr. John R Sanborn |
First Address | Birmingham, MI 48009-0932 |
Second Address | Birmingham, MI 48009-0932 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2005 |
Last Update Date | 22/07/2009 |