Provider Demographics
NPI:1205802816
Name:SANDERS, JERALD GAIL (MD)
Entity type:Individual
Prefix:
First Name:JERALD
Middle Name:GAIL
Last Name:SANDERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:275 SE CABOT DR
Mailing Address - Street 2:STE B101
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-3715
Mailing Address - Country:US
Mailing Address - Phone:360-675-6648
Mailing Address - Fax:360-679-2487
Practice Address - Street 1:275 SE CABOT DR
Practice Address - Street 2:SUITE B101
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-3715
Practice Address - Country:US
Practice Address - Phone:360-675-6648
Practice Address - Fax:360-679-2487
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2013-08-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00018969207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8899870Medicare PIN