Provider Demographics
NPI:1356566384
Name:FUNG, SANFORD (MD)
Entity type:Individual
Prefix:
First Name:SANFORD
Middle Name:
Last Name:FUNG
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 1:105 OVILLA OAKS DR
Mailing Address - Street 2:
Mailing Address - City:OVILLA
Mailing Address - State:TX
Mailing Address - Zip Code:75154-5609
Mailing Address - Country:US
Mailing Address - Phone:469-432-4004
Mailing Address - Fax:877-853-9435
Practice Address - Street 1:105 OVILLA OAKS DR
Practice Address - Street 2:
Practice Address - City:OVILLA
Practice Address - State:TX
Practice Address - Zip Code:75154-5609
Practice Address - Country:US
Practice Address - Phone:469-432-4004
Practice Address - Fax:877-853-9435
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3651207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL3651OtherPHYSICIAN
TXL3651OtherPHYSICIAN