Provider Demographics
NPI:1689679524
Name:SANDERS, RODNEY CLARK (MD)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:CLARK
Last Name:SANDERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1848 PARKLAND DRIVE NE
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058
Mailing Address - Country:US
Mailing Address - Phone:256-739-2885
Mailing Address - Fax:256-739-2898
Practice Address - Street 1:1848 PARKLAND DRIVE NE
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058
Practice Address - Country:US
Practice Address - Phone:256-739-2885
Practice Address - Fax:256-739-2898
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18950174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000031996Medicaid
AL000024092Medicaid
AL19-10132OtherUNITEDHEALTHCARE PROVIDER
AL000025759Medicaid
AL051031996OtherBC-BS OF ALABAMA PROVIDER
AL340009944OtherRR MEDICARE PROVIDER
AL051024092OtherBC-BS OF ALABAMA PROVIDER
AL051512140OtherBC-BS OF ALABAMA PROVIDER
AL009908135Medicaid
AL5918885-001OtherCIGNA PROVIDER
AL051025759OtherBC-BS OF ALABAMA PROVIDER
AL051024092OtherBC-BS OF ALABAMA PROVIDER
AL000025759Medicare ID - Type UnspecifiedALABAMA MEDICARE PROVIDE
AL000024092Medicare ID - Type UnspecifiedALABAMA MEDICARE PROVIDER
AL000031996Medicaid