Provider Demographics
NPI:1609815091
Name:ALEXANDER, SANDRA R (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:R
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 E LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-3301
Mailing Address - Country:US
Mailing Address - Phone:251-943-5689
Mailing Address - Fax:251-943-1041
Practice Address - Street 1:1905 CALLE BARCELONA
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-8450
Practice Address - Country:US
Practice Address - Phone:858-554-1212
Practice Address - Fax:858-554-1212
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC169320208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB355121Medicaid
AL051516488OtherBLUE CROSS
AL051553580Medicaid
AL051553580Medicaid