Provider Demographics
NPI:1003892274
Name:SANDERFORD, JAMES L JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:SANDERFORD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1365 WESTGATE CENTER DR
Mailing Address - Street 2:SUITE K-1
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2980
Mailing Address - Country:US
Mailing Address - Phone:336-760-4450
Mailing Address - Fax:336-760-6197
Practice Address - Street 1:1365 WESTGATE CENTER DR
Practice Address - Street 2:SUITE K-1
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2980
Practice Address - Country:US
Practice Address - Phone:336-760-4450
Practice Address - Fax:336-760-6197
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC240422085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC82404Medicare UPIN
NC213408PMedicare PIN
NC213408JMedicare ID - Type Unspecified