Provider Demographics
NPI:1477594521
Name:SANABRIA, JOHN DARRYL (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DARRYL
Last Name:SANABRIA
Suffix:
Gender:M
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:PO BOX 24175
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37933
Mailing Address - Country:US
Mailing Address - Phone:865-758-1577
Mailing Address - Fax:865-458-1596
Practice Address - Street 1:15000 HWY 72 NORTH
Practice Address - Street 2:
Practice Address - City:LOUDON
Practice Address - State:TN
Practice Address - Zip Code:37774
Practice Address - Country:US
Practice Address - Phone:865-458-1577
Practice Address - Fax:865-458-1596
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28120207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3071947OtherBCBS
TN3071947OtherBCBS