Provider Demographics
NPI:1275503047
Name:SANDERS, JAMES O (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:O
Last Name:SANDERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 665
Mailing Address - Street 2:601 ELMWOOD AVENUE
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-1395
Mailing Address - Fax:585-276-1897
Practice Address - Street 1:601 ELMWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-1395
Practice Address - Fax:585-276-1897
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218898207X00000X, 207XP3100X
PAMD061168L207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA208880540Medicaid
PA208880540Medicaid
NYRB6477Medicare UPIN