Provider Demographics
NPI:1083806525
Name:SANDOVAL, ALEXIUS ENRIQUE GARCIA (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXIUS ENRIQUE
Middle Name:GARCIA
Last Name:SANDOVAL
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 1:905 UNION ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3050
Mailing Address - Country:US
Mailing Address - Phone:207-973-8998
Mailing Address - Fax:207-973-7391
Practice Address - Street 1:905 UNION ST
Practice Address - Street 2:SUITE 9
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3050
Practice Address - Country:US
Practice Address - Phone:207-973-8998
Practice Address - Fax:207-973-7391
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 60080618208100000X
MDD81913208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation