1619947124 NPI number — DAVID A SANDLER M.D.

Table of content: DAVID A SANDLER M.D. (NPI 1619947124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619947124 NPI number — DAVID A SANDLER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANDLER
Provider First Name:
DAVID
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619947124
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9228 S MINGO RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74133-5718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-592-0999
Provider Business Mailing Address Fax Number:
918-878-2499

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1265 S UTICA AVE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74104-4243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-592-0999
Provider Business Practice Location Address Fax Number:
918-592-1021
Provider Enumeration Date:
01/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  23358 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0001X , with the licence number: 23358 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00611413 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: 200010010A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: OK400765 . This is a "MEDICARE PTAN" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: P00051358 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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