Provider Demographics
NPI:1790898146
Name:SANDERS, JEFFREY S (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
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 1:601 W STATE HIGHWAY 6
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-5575
Mailing Address - Country:US
Mailing Address - Phone:254-741-6113
Mailing Address - Fax:254-741-6629
Practice Address - Street 1:601 W STATE HIGHWAY 6
Practice Address - Street 2:SUITE 105
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-5575
Practice Address - Country:US
Practice Address - Phone:254-741-6113
Practice Address - Fax:254-741-6629
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4498208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117026803Medicaid
TX117026803Medicaid
TX81140KMedicare ID - Type Unspecified