Provider Demographics
NPI:1760453997
Name:SANDERS, DANNY LOUIS (MD)
Entity Type:Individual
Prefix:
First Name:DANNY
Middle Name:LOUIS
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 1:454 E PRESIDENT AVE
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-5501
Mailing Address - Country:US
Mailing Address - Phone:662-377-6470
Mailing Address - Fax:662-377-6470
Practice Address - Street 1:4381 S EASON BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6583
Practice Address - Country:US
Practice Address - Phone:662-377-6470
Practice Address - Fax:662-377-6475
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16481208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00051022Medicaid
MS00051022Medicaid
MSH85124Medicare UPIN