Provider Demographics
NPI:1790750297
Name:SANDERS, BRENT C (MD)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:C
Last Name:SANDERS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2501 E SOUTHERN AVE
Mailing Address - Street 2:20
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7669
Mailing Address - Country:US
Mailing Address - Phone:480-969-3773
Mailing Address - Fax:480-969-3031
Practice Address - Street 1:2501 E SOUTHERN AVE
Practice Address - Street 2:20
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7669
Practice Address - Country:US
Practice Address - Phone:480-969-3773
Practice Address - Fax:480-969-3031
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-20
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
AZ6754207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ037574Medicare UPIN