Provider Demographics
NPI:1518227271
Name:SANDERS, HERBERT LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:LAWRENCE
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:PO BOX 639
Mailing Address - Street 2:
Mailing Address - City:LAKE LURE
Mailing Address - State:NC
Mailing Address - Zip Code:28746-0639
Mailing Address - Country:US
Mailing Address - Phone:340-626-1045
Mailing Address - Fax:321-256-5999
Practice Address - Street 1:210 WOLF CREEK DRIVE
Practice Address - Street 2:
Practice Address - City:LAKE LURE
Practice Address - State:NC
Practice Address - Zip Code:28746
Practice Address - Country:US
Practice Address - Phone:340-626-1045
Practice Address - Fax:321-256-5999
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG29489174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist