Provider Demographics
NPI:1275757015
Name:E. WAYNE SANDERS, JR. MD, INC.
Entity Type:Organization
Organization Name:E. WAYNE SANDERS, JR. MD, INC.
Other - Org Name:BAY MEDICAL CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-375-2836
Mailing Address - Street 1:PO BOX 2270
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94966-2270
Mailing Address - Country:US
Mailing Address - Phone:510-331-2788
Mailing Address - Fax:510-653-7159
Practice Address - Street 1:3706 TELEGRAPH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-2418
Practice Address - Country:US
Practice Address - Phone:510-375-2836
Practice Address - Fax:510-653-7159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC29998208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherFED TAX ID
A34086Medicare UPIN
00C299981Medicare ID - Type UnspecifiedMEDICARE TELEGRAPH AVE.