MEDICARE: DR. RYAN MARK SANBORN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171000000X	Military Health Care Provider

General Provider Information

NPI Number	:	1063359347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN MARK SANBORN MD

Provider Business Mailing Address
First Line	:	1100 WILFORD HALL LOOP BLDG 455459
Second Line	:
City	:	JBSA LACKLAND
State	:	TX
Zip	:	78236-5638
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3551 ROGER BROOKE DR
Second Line	:
City	:	FORT SAM HOUSTON
State	:	TX
Zip	:	78234-4504
Country	:	US
Telephone Number	:	210-916-1284
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/06/2026

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