Provider Demographics
NPI:1831468552
Name:SANDERS, GREGORY F
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:F
Last Name:SANDERS
Suffix:
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 1:1211 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-5526
Mailing Address - Country:US
Mailing Address - Phone:817-613-8740
Mailing Address - Fax:871-341-6455
Practice Address - Street 1:1211 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5526
Practice Address - Country:US
Practice Address - Phone:817-613-8740
Practice Address - Fax:871-341-6455
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-27
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11030237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist