Provider Demographics
NPI:1952503948
Name:SANDERS, GEREMY LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:GEREMY
Middle Name:LEE
Last Name:SANDERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 W 38TH ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1188
Mailing Address - Country:US
Mailing Address - Phone:512-329-5705
Mailing Address - Fax:512-329-5720
Practice Address - Street 1:911 W 38TH ST
Practice Address - Street 2:SUITE 303
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1188
Practice Address - Country:US
Practice Address - Phone:512-329-5705
Practice Address - Fax:512-329-5720
Is Sole Proprietor?:No
Enumeration Date:2007-06-03
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN4472207L00000X
LAMD.201672207LP2900X
TXN7869207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8DA966OtherBCBS OF TX
LA1020672Medicaid
MS05205332Medicaid
TX8DA966OtherBCBS OF TX