Provider Demographics
NPI:1790339612
Name:SANDERS, EDWARD JR
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:SANDERS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 WALNUT BEND LN APT 3207
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-4754
Mailing Address - Country:US
Mailing Address - Phone:832-396-3747
Mailing Address - Fax:
Practice Address - Street 1:4219 RICHMOND AVE STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-6838
Practice Address - Country:US
Practice Address - Phone:713-487-0001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant