Provider Demographics
NPI:1265480305
Name:SANDERS, JONATHAN (MD JD)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:SANDERS
Suffix:
Gender:M
Credentials:MD JD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 35TH LN
Mailing Address - Street 2:SUITE 202
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-6521
Mailing Address - Country:US
Mailing Address - Phone:772-778-7782
Mailing Address - Fax:772-778-7879
Practice Address - Street 1:1155 35TH LN
Practice Address - Street 2:SUITE 202
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6521
Practice Address - Country:US
Practice Address - Phone:772-778-7782
Practice Address - Fax:772-778-7879
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87851207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00033828OtherRAILROAD MEDICARE
FLU0856YOtherMEDICARE
FL1265480305Medicare PIN
FLU0856YOtherMEDICARE