Provider Demographics
NPI:1467450403
Name:SANDS, MARY ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:SANDS
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:PO BOX 73152
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77273-3152
Mailing Address - Country:US
Mailing Address - Phone:713-467-5700
Mailing Address - Fax:713-467-5702
Practice Address - Street 1:13700 MEDICAL COMPLEX DR
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-6554
Practice Address - Country:US
Practice Address - Phone:713-467-5700
Practice Address - Fax:713-467-5702
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ29812085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00DT11OtherBLUE CROSS
TX760377143OtherTAX IDENTIFICATION NUMBER
TX037031402Medicaid
TX8A0674Medicare ID - Type Unspecified
TX00DT11OtherBLUE CROSS