Healthcare Provider Details

I. General information

NPI: 1477594521
Provider Name (Legal Business Name): JOHN DARRYL SANABRIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15000 HWY 72 NORTH
LOUDON TN
37774
US

IV. Provider business mailing address

PO BOX 24175
KNOXVILLE TN
37933
US

V. Phone/Fax

Practice location:
  • Phone: 865-458-1577
  • Fax: 865-458-1596
Mailing address:
  • Phone: 865-758-1577
  • Fax: 865-458-1596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28120
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: