Provider Demographics
NPI:1093730954
Name:SANDEN, MATS O (MD)
Entity Type:Individual
Prefix:
First Name:MATS
Middle Name:O
Last Name:SANDEN
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:PO BOX 741087
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1087
Mailing Address - Country:US
Mailing Address - Phone:850-494-5550
Mailing Address - Fax:850-494-3328
Practice Address - Street 1:8383 N DAVIS HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6039
Practice Address - Country:US
Practice Address - Phone:850-494-5550
Practice Address - Fax:850-494-3328
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME137648207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7714009Medicaid
NJ7714009Medicaid
NJ020368NYWMedicare ID - Type Unspecified