Provider Demographics
NPI:1063479053
Name:SANDERS, RAYMOND JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:JOSEPH
Last Name:SANDERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 S YALE AVE
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3347
Mailing Address - Country:US
Mailing Address - Phone:918-488-6001
Mailing Address - Fax:
Practice Address - Street 1:6151 S YALE AVE
Practice Address - Street 2:LEVEL B
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1907
Practice Address - Country:US
Practice Address - Phone:918-502-6044
Practice Address - Fax:918-502-6046
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK254522080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR165489001Medicaid
OK200104900AMedicaid
MO206347304Medicaid
KS200461180AMedicaid
AR165489001Medicaid