Provider Demographics
NPI:1003817040
Name:SANDERS, MICHAEL CLORE (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CLORE
Last Name:SANDERS
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 1:301 HEALTH PARK BLVD
Mailing Address - Street 2:SUITE 327
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5771
Mailing Address - Country:US
Mailing Address - Phone:904-825-3606
Mailing Address - Fax:904-825-0753
Practice Address - Street 1:301 HEALTH PARK BLVD
Practice Address - Street 2:SUITE 327
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5771
Practice Address - Country:US
Practice Address - Phone:904-825-3606
Practice Address - Fax:904-825-0753
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-01
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0051448207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
05969OtherBCBS OF FL
080012676OtherRAILROAD MEDICARE
FL047989600Medicaid
05969OtherBCBS OF FL
D61321Medicare UPIN