Provider Demographics
NPI:1902232309
Name:SANDERS, CRAIG E
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:E
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 1:604 NW 121ST ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-8307
Mailing Address - Country:US
Mailing Address - Phone:405-882-2224
Mailing Address - Fax:405-255-7326
Practice Address - Street 1:604 NW 121ST ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73114-8307
Practice Address - Country:US
Practice Address - Phone:405-882-2224
Practice Address - Fax:405-255-7326
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management