Provider Demographics
NPI:1205818127
Name:SANDERS, TIMOTHY GENE (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:GENE
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 1:629A E HILLSBORO BLVD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-3517
Mailing Address - Country:US
Mailing Address - Phone:954-698-9399
Mailing Address - Fax:954-698-6963
Practice Address - Street 1:629A E HILLSBORO BLVD
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-3517
Practice Address - Country:US
Practice Address - Phone:954-698-9399
Practice Address - Fax:954-698-6963
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-44032085R0202X
TXL46912085R0202X
AZ371002085R0202X
MI43015077752085R0202X
FL604212085R0202X
VA01012350122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ315609Medicaid
AZZ122292Medicare PIN
AZ315609Medicaid
FL26877BMedicare NSC
VAMC12208Medicare PIN