Provider Demographics
NPI:1740219617
Name:SANDER, DARYL RAY (MD)
Entity Type:Individual
Prefix:DR
First Name:DARYL
Middle Name:RAY
Last Name:SANDER
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 1:1593 OLENTANGY RD.
Mailing Address - Street 2:
Mailing Address - City:GALION
Mailing Address - State:OH
Mailing Address - Zip Code:44833-1509
Mailing Address - Country:US
Mailing Address - Phone:419-468-7785
Mailing Address - Fax:419-468-7295
Practice Address - Street 1:1593 OLENTANGY RD.
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-1509
Practice Address - Country:US
Practice Address - Phone:419-468-7785
Practice Address - Fax:419-468-7295
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.053287208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0825781Medicaid
OHSA0695771Medicare ID - Type Unspecified
OHE92083Medicare UPIN