Provider Demographics
NPI:1164421103
Name:SANDERS, LAWRENCE W (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:W
Last Name:SANDERS
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 1:2200 HIGHWAY 365
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-5506
Mailing Address - Country:US
Mailing Address - Phone:409-722-4321
Mailing Address - Fax:409-729-2332
Practice Address - Street 1:2200 HIGHWAY 365
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-5506
Practice Address - Country:US
Practice Address - Phone:409-722-4321
Practice Address - Fax:409-729-2332
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5568207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126853406Medicaid
8510M2OtherBCBS OF TX PROVIDER #
C21542Medicare UPIN
8510M2Medicare ID - Type Unspecified