Provider Demographics
NPI:1285635813
Name:SANDER, HANS MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:HANS
Middle Name:MICHAEL
Last Name:SANDER
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 1:11410 JOLLYVILLE RD
Mailing Address - Street 2:SUITE 2101
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4097
Mailing Address - Country:US
Mailing Address - Phone:512-345-8688
Mailing Address - Fax:512-345-2253
Practice Address - Street 1:11410 JOLLYVILLE RD
Practice Address - Street 2:SUITE 2101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4097
Practice Address - Country:US
Practice Address - Phone:512-345-8688
Practice Address - Fax:512-345-2253
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2017-08-08
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-04-12
Provider Licenses
StateLicense IDTaxonomies
TXG5567207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00999UMedicare ID - Type UnspecifiedMEDICARE GROUP ID
TXD67723Medicare UPIN