Provider Demographics
NPI:1265654750
Name:MARC R. SANDERS, M.D., P.A.
Entity type:Organization
Organization Name:MARC R. SANDERS, M.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:R
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:713-797-1500
Mailing Address - Street 1:3405 EDLOE ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-6520
Mailing Address - Country:US
Mailing Address - Phone:713-797-1500
Mailing Address - Fax:713-797-1150
Practice Address - Street 1:3405 EDLOE ST
Practice Address - Street 2:SUITE 300
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-6520
Practice Address - Country:US
Practice Address - Phone:713-797-1500
Practice Address - Fax:713-797-1150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6115TG152W00000X
TX8187T152W00000X
TXJ3593207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCG6329OtherMEDICARE RAILROAD
TX080929501Medicaid
TX687760OtherAETNA
TX0077EBOtherBCBS GROUP
TX687760OtherAETNA
TX4189260002Medicare NSC
TX00646NMedicare PIN
TXCG6329OtherMEDICARE RAILROAD
TXE94395Medicare UPIN