Provider Demographics
NPI:1477640944
Name:DUNBRASKY, SANDRA (MD)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:DUNBRASKY
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 1:1219 SW 4TH AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914
Mailing Address - Country:US
Mailing Address - Phone:541-889-2668
Mailing Address - Fax:541-889-2997
Practice Address - Street 1:1219 SW 4TH AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914
Practice Address - Country:US
Practice Address - Phone:541-889-2668
Practice Address - Fax:541-889-2997
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17772208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR048962Medicaid
ID000010005327OtherBLUE SHIELD OF ID
OR055336002OtherBLUE CROSS OF OREGON
1040301OtherPACIFIC SOURCE
ID003424800Medicaid
OR931141856OtherTIN
ID000010005327OtherBLUE SHIELD OF ID