Provider Demographics
NPI:1164960142
Name:LAURIE P. SANSBURY, JR. D.O. P.A.
Entity Type:Organization
Organization Name:LAURIE P. SANSBURY, JR. D.O. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:POWERS
Authorized Official - Last Name:SANSBURY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:850-512-7789
Mailing Address - Street 1:7164 INNISWOLD DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32526-8034
Mailing Address - Country:US
Mailing Address - Phone:850-512-7789
Mailing Address - Fax:888-636-4127
Practice Address - Street 1:7164 INNISWOLD DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32526-8034
Practice Address - Country:US
Practice Address - Phone:850-512-7789
Practice Address - Fax:888-636-4127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11621207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty