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Individual

DR. JEAN A SANSARICQ

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
524 STANTON RD, MOBILE, AL 36617-2343
(251) 479-0058
(251) 479-1585
Mailing address
PO BOX 7627, MOBILE, AL 36670
(251) 633-0573
(251) 633-7367

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
17868
AL
207V00000X
Obstetrics & Gynecology Physician
Primary
17868
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
009982570
AL
01
51506914
BCBS PROVIDER NUMBER
AL
Enumeration date
07/11/2006
Last updated
02/07/2018
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