Provider Demographics
NPI:1508855529
Name:SANDERS, MARC R (MD, PA)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:R
Last Name:SANDERS
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3405 EDLOE ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-6520
Mailing Address - Country:US
Mailing Address - Phone:713-797-1500
Mailing Address - Fax:713-797-1150
Practice Address - Street 1:3405 EDLOE ST
Practice Address - Street 2:SUITE 300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-6520
Practice Address - Country:US
Practice Address - Phone:713-797-1500
Practice Address - Fax:713-797-1150
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3593207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133642202Medicaid
TX84920YOtherBLUE CROSS BLUE SHIELD
TX180034605OtherMEDICARE RAILROAD
TX180034605OtherMEDICARE RAILROAD
TX84920YOtherBLUE CROSS BLUE SHIELD
TX4189260001Medicare NSC