Provider Demographics
NPI:1700846789
Name:SANDERS, DOUGLAS WILLIS (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:WILLIS
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 1:3435 S HIGHLANDS AVE
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-5408
Mailing Address - Country:US
Mailing Address - Phone:863-385-8777
Mailing Address - Fax:863-385-6585
Practice Address - Street 1:3435 S HIGHLANDS AVE
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-5408
Practice Address - Country:US
Practice Address - Phone:863-385-8777
Practice Address - Fax:863-385-6585
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00068562208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002887200Medicaid
FL38028Medicare PIN
FLG60341Medicare UPIN