Provider Demographics
NPI:1336546936
Name:SANDERSON, STANLEY (CO)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:
Last Name:SANDERSON
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17490 HIGHWAY 3 STE 100A
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4160
Mailing Address - Country:US
Mailing Address - Phone:281-332-4888
Mailing Address - Fax:281-332-1834
Practice Address - Street 1:17490 HIGHWAY 3 STE 100A
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4160
Practice Address - Country:US
Practice Address - Phone:281-332-4888
Practice Address - Fax:281-332-1834
Is Sole Proprietor?:No
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX182174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist