Provider Demographics
NPI:1184717803
Name:SANDERS, JOANN M (MD)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:M
Last Name:SANDERS
Suffix:
Gender:F
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:PO BOX 99371
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0371
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-7347
Practice Address - Street 1:1500 COOPER ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2710
Practice Address - Country:US
Practice Address - Phone:682-885-4007
Practice Address - Fax:682-885-4004
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH56232080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3108280OtherCIGNA PIN
TX137345808Medicaid
TX4133086OtherAETNA PIN
TX134733808Medicaid
TX526517OtherFIRSTHEALTH PIN
TX81X461OtherBCBSTX IND PIN
TX10028772OtherAMERIGROUP PIN
TX123213101OtherFIRSTCARE PIN
TX60270OtherUHC PIN
TX00U87ZOtherBCBSTX GRP PIN
TX083880701Medicaid
TX124185OtherSUPERIOR PIN
TX526517OtherFIRSTHEALTH PIN
TX10028772OtherAMERIGROUP PIN
TX137345808Medicaid