Provider Demographics
NPI:1033112255
Name:SANDERS, CHARLES E JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:E
Last Name:SANDERS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:409 BAYSHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2707
Mailing Address - Country:US
Mailing Address - Phone:800-844-9302
Mailing Address - Fax:813-844-1655
Practice Address - Street 1:12662 TELECOM DR
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33637-0935
Practice Address - Country:US
Practice Address - Phone:813-910-8708
Practice Address - Fax:855-852-7153
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62847207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18235XOtherMEDICARE PTAN
FL371667800Medicaid
FL371667800Medicaid
FL18235XOtherMEDICARE PTAN