Provider Demographics
NPI:1558033167
Name:DAVID G. SANFORD, M.D., P.S.C.
Entity Type:Organization
Organization Name:DAVID G. SANFORD, M.D., P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-248-0932
Mailing Address - Street 1:1502 CUMBERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965-1223
Mailing Address - Country:US
Mailing Address - Phone:606-248-0932
Mailing Address - Fax:
Practice Address - Street 1:409 N BROAD ST
Practice Address - Street 2:
Practice Address - City:NEW TAZEWELL
Practice Address - State:TN
Practice Address - Zip Code:37825-6607
Practice Address - Country:US
Practice Address - Phone:423-615-4372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVID G SANFORD, M.D., P.S.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000284679OtherANTHEM GROUP NUMBER