Provider Demographics
NPI:1386646339
Name:SANDS, MARK R (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:SANDS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4572
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4572
Mailing Address - Country:US
Mailing Address - Phone:281-996-9546
Mailing Address - Fax:281-996-7645
Practice Address - Street 1:119 E EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-3818
Practice Address - Country:US
Practice Address - Phone:281-996-9546
Practice Address - Fax:281-996-7645
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1076213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0004328912OtherAETNA PROVIDER ID
TXP00174690OtherRAILROAD MEDICARE
TX119842602Medicaid
TX8M1220OtherBLUE CROSS BLUE SHIELD
TX119842602Medicaid
TX8M1220OtherBLUE CROSS BLUE SHIELD
TX83270BMedicare PIN