Provider Demographics
NPI:1821185190
Name:HANS M SANDER MD PA
Entity Type:Organization
Organization Name:HANS M SANDER MD PA
Other - Org Name:CAPITOL DERMATOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HANS
Authorized Official - Middle Name:M
Authorized Official - Last Name:SANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:512-345-8688
Mailing Address - Street 1:11410 JOLLYVILLE RD
Mailing Address - Street 2:SUITE 2101
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4097
Mailing Address - Country:US
Mailing Address - Phone:512-345-8688
Mailing Address - Fax:512-345-2253
Practice Address - Street 1:11410 JOLLYVILLE RD
Practice Address - Street 2:SUITE 2101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4097
Practice Address - Country:US
Practice Address - Phone:512-345-8688
Practice Address - Fax:512-345-2253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5567174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD67723Medicare UPIN
TX00999UMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
TX8A6192Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL NUMBE