1255677688 NPI number — MARK S SANDERS MD PA

Table of content: (NPI 1255677688)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255677688 NPI number — MARK S SANDERS MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARK S SANDERS MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1255677688
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5177 RICHMOND AVE STE 250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77056-6718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-622-3576
Provider Business Mailing Address Fax Number:
713-622-3615

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5177 RICHMOND AVE STE 250
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77056-6718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-622-3576
Provider Business Practice Location Address Fax Number:
713-622-3615
Provider Enumeration Date:
12/12/2012

Additional Information

Authorized Official

Authorized Official Last Name:
SANDERS
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
M.D.
Authorized Official Telephone Number:
713-622-3576

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  H0002 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8DN944 . This is a "BLUE CROSS BLUE SHILD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 099095401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4139015 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0620977 . This is a "CIGNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2160583 . This is a "BCBS BLUE LINK" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 175861111581 . This is a "HUMANA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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