Provider Demographics
NPI:1265437719
Name:SANDERS, ZACK G (MD)
Entity type:Individual
Prefix:DR
First Name:ZACK
Middle Name:G
Last Name:SANDERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2400 HOSPITAL DR
Mailing Address - Street 2:STE 120
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2386
Mailing Address - Country:US
Mailing Address - Phone:318-742-6710
Mailing Address - Fax:318-747-5393
Practice Address - Street 1:2400 HOSPITAL DR
Practice Address - Street 2:STE 120
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2386
Practice Address - Country:US
Practice Address - Phone:318-742-6710
Practice Address - Fax:318-747-5393
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014111208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1309451Medicaid
E69811Medicare UPIN