Provider Demographics
NPI:1477523322
Name:SANDER, CRAIG J (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:J
Last Name:SANDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6215 HUMPHREYS BLVD
Mailing Address - Street 2:STE 310
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2367
Mailing Address - Country:US
Mailing Address - Phone:901-747-0291
Mailing Address - Fax:901-747-0299
Practice Address - Street 1:6215 HUMPHREYS BLVD
Practice Address - Street 2:STE 310
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2367
Practice Address - Country:US
Practice Address - Phone:901-747-0291
Practice Address - Fax:901-747-0299
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD00000133622080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5006696Medicaid
TN5006696Medicaid
G67089Medicare UPIN