Provider Demographics
NPI:1366435455
Name:HEBBAR, SANJAYA (MD)
Entity type:Individual
Prefix:DR
First Name:SANJAYA
Middle Name:
Last Name:HEBBAR
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 1:10370 N LA CANADA DR STE 150
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-7270
Mailing Address - Country:US
Mailing Address - Phone:520-544-4100
Mailing Address - Fax:
Practice Address - Street 1:10370 N LA CANADA DR STE 150
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737-7270
Practice Address - Country:US
Practice Address - Phone:520-544-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO114746207R00000X
KS04-27448207R00000X
AZ35435207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204635007Medicaid
2292242OtherAETNA
337620OtherFIRST GUARD
KS100349090AMedicaid
25819019OtherBCBS
MO204635007Medicaid
337620OtherFIRST GUARD
25819019OtherBCBS
110200492Medicare ID - Type UnspecifiedRR MCR
MOI148446BMedicare ID - Type UnspecifiedRURAL MO
AZZ115086Medicare PIN