Provider Demographics
NPI:1205812187
Name:SANDERS, B JEFFREY (MD)
Entity type:Individual
Prefix:
First Name:B
Middle Name:JEFFREY
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:PO BOX 535744
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-5510
Mailing Address - Country:US
Mailing Address - Phone:844-294-5114
Mailing Address - Fax:865-691-0843
Practice Address - Street 1:135 W. RAVINE ROAD
Practice Address - Street 2:SUITE 5-B
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3847
Practice Address - Country:US
Practice Address - Phone:423-224-3460
Practice Address - Fax:423-224-3465
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21771207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3069107OtherBLUECROSS BLUESHIELD
VA1205812187Medicaid
TN3074914Medicaid
AR97016OtherBLUECROSS BLUESHIELD
TNE91054Medicare UPIN
TN3069107OtherBLUECROSS BLUESHIELD
TN3074917Medicare ID - Type Unspecified
MS07631573Medicaid
TN3069107OtherBLUECROSS BLUESHIELD
MO208129106Medicaid