Provider Demographics
NPI:1669490447
Name:SANDERSON, TERRY ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:ALLEN
Last Name:SANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TERRY
Other - Middle Name:ALLEN
Other - Last Name:SANDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1526 PLANTATION DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-1318
Mailing Address - Country:US
Mailing Address - Phone:281-239-0135
Mailing Address - Fax:281-239-0114
Practice Address - Street 1:1500 WEST LOOP N
Practice Address - Street 2:#137
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-5000
Practice Address - Country:US
Practice Address - Phone:713-880-9800
Practice Address - Fax:713-880-3330
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD1039208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC21543Medicare UPIN