Provider Demographics
NPI:1386904639
Name:MCLEAN R SANBORN, MD, PA
Entity type:Organization
Organization Name:MCLEAN R SANBORN, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MCLEAN
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:SANBORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-627-0013
Mailing Address - Street 1:2014 BEN MERRITT DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-3850
Mailing Address - Country:US
Mailing Address - Phone:940-627-0013
Mailing Address - Fax:940-627-1900
Practice Address - Street 1:2014 BEN MERRITT DR
Practice Address - Street 2:SUITE A
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3850
Practice Address - Country:US
Practice Address - Phone:940-627-0013
Practice Address - Fax:940-627-1900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8453207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGOtherBCBS
TXPENDINGMedicaid
TXPENDINGOtherBCBS