Provider Demographics
NPI:1851631378
Name:SANDERS, MATTHEW (PA)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:
Last Name:SANDERS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:MATTHEW
Other - Middle Name:
Other - Last Name:JARVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1700 WHEELER PEAK DR.
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106
Mailing Address - Country:US
Mailing Address - Phone:702-383-2565
Mailing Address - Fax:702-646-0298
Practice Address - Street 1:1700 WHEELER PEAK DR.
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106
Practice Address - Country:US
Practice Address - Phone:702-383-2565
Practice Address - Fax:702-646-0298
Is Sole Proprietor?:No
Enumeration Date:2013-02-20
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1415363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPA1415OtherPA LICENSE