Provider Demographics
NPI:1629039342
Name:SANFORD, DAVID B (M D)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:SANFORD
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 FROSTWOOD DR
Mailing Address - Street 2:SUITE 315
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2420
Mailing Address - Country:US
Mailing Address - Phone:713-800-0656
Mailing Address - Fax:713-827-1380
Practice Address - Street 1:2130 W HOLCOMBE BLVD
Practice Address - Street 2:10TH FLOOR
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3304
Practice Address - Country:US
Practice Address - Phone:713-600-0900
Practice Address - Fax:713-600-0070
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6575207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85271NOtherBLUECHOICE
10014425OtherAMERICAID
TX136814410Medicaid
TX136814412Medicaid
3375636OtherBLUE LINK#
4479363OtherAETNA
830005871OtherRAILROAD MEDICARE
TX136814411Medicaid
25167OtherAMERIGROUP
830005871OtherRAILROAD MEDICARE
TX85271NOtherBLUECHOICE