Provider Demographics
NPI:1376511097
Name:BOXELL, SANDRA J (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:J
Last Name:BOXELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 HARTFORD SQ
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-8519
Mailing Address - Country:US
Mailing Address - Phone:731-521-1080
Mailing Address - Fax:
Practice Address - Street 1:72 PHYSICIANS DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2070
Practice Address - Country:US
Practice Address - Phone:731-668-4455
Practice Address - Fax:731-668-9007
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35599174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4015715OtherBLUE CROSS BLUE SHIELD
TNH45334Medicare UPIN
TN3866904Medicare ID - Type Unspecified