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General NPI Number Information
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NPI Number | 1932468527
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Entity Type | Individual
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Provider Name | NICHOLAS PETER SANBORN M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/16/2012
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Last Update Date | 06/02/2016
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Provider Practice Location Address
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Address Line | 6401 FRANCE AVE S
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City | EDINA
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State | MN
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Zip | 55435-2104
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Country | US
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Telephone | 952-924-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 63 TAMARACK ST
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City | MAHTOMEDI
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State | MN
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Zip | 55115-1950
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Country | US
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Telephone | 651-769-4648
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | BP10043698
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License Number State | TX
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