1184717803 NPI number — JOANN M SANDERS MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184717803 NPI number — JOANN M SANDERS MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SANDERS

Provider First Name:

JOANN

Provider Middle Name:

M

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

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:

1184717803

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/20/2012

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 99371

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

FORT WORTH

Provider Business Mailing Address State Name:

TX

Provider Business Mailing Address Postal Code:

76199-0371

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

682-885-1855

Provider Business Mailing Address Fax Number:

682-885-7347

Provider First Line Business Practice Location Address:

1500 COOPER ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

FORT WORTH

Provider Business Practice Location Address State Name:

TX

Provider Business Practice Location Address Postal Code:

76104-2710

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

682-885-4007

Provider Business Practice Location Address Fax Number:

682-885-4004

Provider Enumeration Date:

10/02/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2080P0207X , with the licence number:  H5623 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 3108280 . This is a "CIGNA PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 137345808 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 4133086 . This is a "AETNA PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 134733808 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 526517 . This is a "FIRSTHEALTH PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 81X461 . This is a "BCBSTX IND PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 10028772 . This is a "AMERIGROUP PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 123213101 . This is a "FIRSTCARE PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 60270 . This is a "UHC PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 00U87Z . This is a "BCBSTX GRP PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 083880701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 124185 . This is a "SUPERIOR PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".