Provider Demographics
NPI:1619196953
Name:SANDERS, JILL E (MD)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:E
Last Name:SANDERS
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 1:6621 FANNIN ST
Mailing Address - Street 2:CC1210
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2303
Mailing Address - Country:US
Mailing Address - Phone:832-822-1038
Mailing Address - Fax:
Practice Address - Street 1:BAYLOR CHILDREN'S FOUNDATION - LESOTHO
Practice Address - Street 2:PRIVATE BAG A191
Practice Address - City:MASERU
Practice Address - State:AFRICA
Practice Address - Zip Code:100
Practice Address - Country:LS
Practice Address - Phone:2662-222-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR390200000X
ARE-5279208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR163884001Medicaid
AR163884001Medicaid