Provider Demographics
NPI:1306815626
Name:SANDERS, SCOTT MITCHELL (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:MITCHELL
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 1:500 S. UNIVERSITY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205
Mailing Address - Country:US
Mailing Address - Phone:501-664-4117
Mailing Address - Fax:501-664-1137
Practice Address - Street 1:500 S UNIVERSITY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5302
Practice Address - Country:US
Practice Address - Phone:501-664-4117
Practice Address - Fax:501-664-1137
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-1901208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR134303001Medicaid
AR5-K800Medicare ID - Type Unspecified
ARG70265Medicare UPIN