Provider Demographics
NPI:1376775908
Name:JASON SANDERS MD PL LLC
Entity Type:Organization
Organization Name:JASON SANDERS MD PL LLC
Other - Org Name:SANDERS CENTER FOR ORTHOPAEDIC EXCELLENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-404-7440
Mailing Address - Street 1:3702 WASHINGTON ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-8282
Mailing Address - Country:US
Mailing Address - Phone:954-404-7440
Mailing Address - Fax:954-404-7402
Practice Address - Street 1:3702 WASHINGTON ST
Practice Address - Street 2:SUITE 404
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8282
Practice Address - Country:US
Practice Address - Phone:954-404-7440
Practice Address - Fax:954-404-7402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-15
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 102131207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6653430001Medicare NSC