Provider Demographics
NPI:1295897726
Name:SANDERS, RICHARD JEROME JR (MD)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JEROME
Last Name:SANDERS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:64040 HIGHWAY 434
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LACOMBE
Mailing Address - State:LA
Mailing Address - Zip Code:70445-3499
Mailing Address - Country:US
Mailing Address - Phone:985-892-9233
Mailing Address - Fax:985-892-8916
Practice Address - Street 1:64040 HIGHWAY 434
Practice Address - Street 2:SUITE 200
Practice Address - City:LACOMBE
Practice Address - State:LA
Practice Address - Zip Code:70445-3499
Practice Address - Country:US
Practice Address - Phone:985-892-9233
Practice Address - Fax:985-892-8916
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2016-03-30
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Provider Licenses
StateLicense IDTaxonomies
LA017339207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1360678Medicaid
LA1360678Medicaid
D79764Medicare UPIN