1063479053 NPI number — DR. RAYMOND JOSEPH SANDERS M.D.

Table of content: (NPI 1376909069)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063479053 NPI number — DR. RAYMOND JOSEPH SANDERS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANDERS
Provider First Name:
RAYMOND
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
DR.
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:
1063479053
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6600 S YALE AVE
Provider Second Line Business Mailing Address:
SUITE 1400
Provider Business Mailing Address City Name:
TULSA
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74136-3347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-488-6001
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6151 S YALE AVE
Provider Second Line Business Practice Location Address:
LEVEL B
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74136-1907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-502-6044
Provider Business Practice Location Address Fax Number:
918-502-6046
Provider Enumeration Date:
04/26/2006

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: 2080N0001X , with the licence number:  25452 , 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: 165489001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200104900A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 206347304 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200461180A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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