Provider Demographics
NPI:1518937101
Name:SANDERLIN, DAMIEN BROUGH (MD)
Entity Type:Individual
Prefix:DR
First Name:DAMIEN
Middle Name:BROUGH
Last Name:SANDERLIN
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 1:8240 ANTOINE DR
Mailing Address - Street 2:STE. #107
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77088-2534
Mailing Address - Country:US
Mailing Address - Phone:281-447-5570
Mailing Address - Fax:281-447-5598
Practice Address - Street 1:8240 ANTOINE DR
Practice Address - Street 2:STE. #107
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77088-2534
Practice Address - Country:US
Practice Address - Phone:281-447-5570
Practice Address - Fax:281-447-5598
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6617207Q00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160859801Medicaid
TX160860601OtherINDIVIDUAL MEDICAID NO
TX8A8986Medicare ID - Type Unspecified
TX160859801Medicaid