Provider Demographics
NPI:1609955566
Name:SANDUSKY, JANE B (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:B
Last Name:SANDUSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:923 GREEN ROCK DR
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-2918
Mailing Address - Country:US
Mailing Address - Phone:972-709-9627
Mailing Address - Fax:
Practice Address - Street 1:777 E WHEATLAND RD
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4918
Practice Address - Country:US
Practice Address - Phone:972-296-9930
Practice Address - Fax:972-709-1340
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD4296208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF40923Medicare UPIN