Provider Demographics
NPI:1295750156
Name:SANDBERG, DAVID IAN (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:IAN
Last Name:SANDBERG
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 1:6431 FANNIN ST
Mailing Address - Street 2:MSB 5.140
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1501
Mailing Address - Country:US
Mailing Address - Phone:713-500-7210
Mailing Address - Fax:713-500-7352
Practice Address - Street 1:6410 FANNIN ST
Practice Address - Street 2:SUITE 950
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3000
Practice Address - Country:US
Practice Address - Phone:832-325-7234
Practice Address - Fax:713-512-2221
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89691207T00000X
TXP3236207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200472300AMedicaid
IN201183080Medicaid
TX300348502Medicaid
FL270063800Medicaid
FL2700638-00Medicaid
FL2700638-00Medicaid
FL44049WMedicare PIN
FL44049Medicare ID - Type Unspecified
TX300348502Medicaid