Provider Demographics
NPI:1508072026
Name:SANDERS, JASON B (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:B
Last Name:SANDERS
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 1:3702 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
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 102131207XS0106X, 207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine