Provider Demographics
NPI:1255677688
Name:MARK S SANDERS MD PA
Entity Type:Organization
Organization Name:MARK S SANDERS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:713-622-3576
Mailing Address - Street 1:PO BOX 27207
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77227-7207
Mailing Address - Country:US
Mailing Address - Phone:713-622-3576
Mailing Address - Fax:713-622-3615
Practice Address - Street 1:4126 SOUTHWEST FWY
Practice Address - Street 2:SUITE 1730
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7310
Practice Address - Country:US
Practice Address - Phone:713-622-3576
Practice Address - Fax:713-622-3615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-12
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0002207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8DN944OtherBLUE CROSS BLUE SHILD
TX099095401Medicaid
TX4139015OtherAETNA
TX0620977OtherCIGNA
TX2160583OtherBCBS BLUE LINK
TX175861111581OtherHUMANA
TX099095401Medicaid
TX00JZ14Medicare PIN