Provider Demographics
NPI:1376593202
Name:SUN, ANN MARIE (MD)
Entity Type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:
Last Name:SUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23129 N 122ND AVE
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85373-5677
Mailing Address - Country:US
Mailing Address - Phone:623-687-1662
Mailing Address - Fax:
Practice Address - Street 1:23129 N 122ND AVE
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85373-5677
Practice Address - Country:US
Practice Address - Phone:623-687-1662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29757207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZH52077Medicare UPIN
AZZ106867Medicare PIN
AZZ114370Medicare PIN
AZZ147883Medicare PIN
AZP00286222Medicare PIN