Provider Demographics
NPI:1013292317
Name:GEREMY L SANDERS MD PA
Entity Type:Organization
Organization Name:GEREMY L SANDERS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF PA
Authorized Official - Prefix:
Authorized Official - First Name:GEREMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-329-5705
Mailing Address - Street 1:911 W 38TH ST STE 303
Mailing Address - Street 2:
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 STE 303
Practice Address - Street 2:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBCBS OF TEXASOther0011XC