Provider Demographics
NPI:1841238706
Name:SANDERS, FRED STEVEN (DO)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:STEVEN
Last Name:SANDERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 4 BOX 57
Mailing Address - Street 2:
Mailing Address - City:OKEMAH
Mailing Address - State:OK
Mailing Address - Zip Code:74859-9308
Mailing Address - Country:US
Mailing Address - Phone:918-623-9383
Mailing Address - Fax:
Practice Address - Street 1:100 MCDOUGAL DR
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:HOLDENVILLE
Practice Address - State:OK
Practice Address - Zip Code:74848-2822
Practice Address - Country:US
Practice Address - Phone:405-379-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2810207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKF25888Medicare UPIN