Provider Demographics
NPI:1124050299
Name:HORNBERGER, SARA GAYLE (DO)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:GAYLE
Last Name:HORNBERGER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:S. GAYLE
Other - Middle Name:
Other - Last Name:HORNBERGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 84888
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99708-4888
Mailing Address - Country:US
Mailing Address - Phone:907-322-6355
Mailing Address - Fax:
Practice Address - Street 1:1717 W COWLES ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5926
Practice Address - Country:US
Practice Address - Phone:907-451-6682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3825207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD7694Medicaid
AKMD7694Medicaid
AKK151816Medicare ID - Type Unspecified