Provider Demographics
NPI:1942244397
Name:SANDER ORTHOPAEDICS AND SPORTS MEDICINE, PA
Entity Type:Organization
Organization Name:SANDER ORTHOPAEDICS AND SPORTS MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:SANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-447-9797
Mailing Address - Street 1:1315 E 6TH STREET
Mailing Address - Street 2:SUITE 10
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596
Mailing Address - Country:US
Mailing Address - Phone:956-447-9797
Mailing Address - Fax:956-447-9696
Practice Address - Street 1:1315 E 6TH STREET
Practice Address - Street 2:SUITE 10
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596
Practice Address - Country:US
Practice Address - Phone:956-447-9797
Practice Address - Fax:956-447-9696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0253207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183392301Medicaid