Provider Demographics
NPI:1245342369
Name:SANDERS, MYRON DEAN (CRNA)
Entity type:Individual
Prefix:MR
First Name:MYRON
Middle Name:DEAN
Last Name:SANDERS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 LONGHORN DR
Mailing Address - Street 2:
Mailing Address - City:LEVELLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79336-6701
Mailing Address - Country:US
Mailing Address - Phone:806-897-0567
Mailing Address - Fax:806-897-0567
Practice Address - Street 1:1900 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:LEVELLAND
Practice Address - State:TX
Practice Address - Zip Code:79336-6508
Practice Address - Country:US
Practice Address - Phone:806-638-0072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX038341367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered