Provider Demographics
NPI:1538320437
Name:SANDERS, KYLE WESLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:WESLEY
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 2019
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87499-2019
Mailing Address - Country:US
Mailing Address - Phone:505-325-1572
Mailing Address - Fax:505-327-4887
Practice Address - Street 1:801 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5630
Practice Address - Country:US
Practice Address - Phone:056-096-2285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA069136202C00000X
GA691362085R0202X
UT9532955-12052085R0204X
ARE-96502085R0204X
WI55072-0202085R0204X
IL036.1406642085R0204X
MO20160091662085R0204X
NMMD2017-08792085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology