Provider Demographics
NPI:1295823151
Name:SANDERS, ROGER COBBAN (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:COBBAN
Last Name:SANDERS
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:HIR 74 BOX 24702
Mailing Address - Street 2:
Mailing Address - City:EL PRADO
Mailing Address - State:NM
Mailing Address - Zip Code:87529
Mailing Address - Country:US
Mailing Address - Phone:505-776-8580
Mailing Address - Fax:505-776-9640
Practice Address - Street 1:4600 MONTGOMERY BLVD NE STE 105A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1292
Practice Address - Country:US
Practice Address - Phone:505-875-1583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM983842085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound