Provider Demographics
NPI:1457469272
Name:SANDERSON, DAVID DUNNING (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:DUNNING
Last Name:SANDERSON
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 1:4800 NE STALLINGS DRIVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965
Mailing Address - Country:US
Mailing Address - Phone:936-569-6252
Mailing Address - Fax:936-569-1919
Practice Address - Street 1:4800 NE STALLINGS DRIVE
Practice Address - Street 2:SUITE 108
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965
Practice Address - Country:US
Practice Address - Phone:936-569-6252
Practice Address - Fax:936-569-1919
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE9969207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
B26153Medicare UPIN
00EH77Medicare ID - Type Unspecified