Provider Demographics
NPI:1063470425
Name:SANDERS, JOHN D (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:SANDERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9275C MEDICAL PLAZA DR
Mailing Address - Street 2:STE C
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406
Mailing Address - Country:US
Mailing Address - Phone:843-797-5667
Mailing Address - Fax:843-569-2215
Practice Address - Street 1:9275C MEDICAL PLAZA DR
Practice Address - Street 2:STE C
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406
Practice Address - Country:US
Practice Address - Phone:843-797-5667
Practice Address - Fax:843-569-2215
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC7176207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC071763Medicaid
SC071763Medicaid
C60420Medicare UPIN