Provider Demographics
NPI:1619297348
Name:SANDERS, ROBERTA LUCILLE (MD PA)
Entity type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:LUCILLE
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MD PA
Other - Prefix:DR
Other - First Name:ROBERTA
Other - Middle Name:LUCILLE
Other - Last Name:VICKERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD PA
Mailing Address - Street 1:PO BOX 6108
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75505
Mailing Address - Country:US
Mailing Address - Phone:903-278-7242
Mailing Address - Fax:
Practice Address - Street 1:2600 ST MICHAEL DR
Practice Address - Street 2:SCP OFFICE
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503
Practice Address - Country:US
Practice Address - Phone:903-278-7242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7018207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine