Provider Demographics
NPI:1649707308
Name:SANDERS, BRIAN (DPM)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:SANDERS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-1404
Mailing Address - Country:US
Mailing Address - Phone:541-524-0122
Mailing Address - Fax:541-524-2120
Practice Address - Street 1:2830 10TH ST
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-1404
Practice Address - Country:US
Practice Address - Phone:541-524-0122
Practice Address - Fax:541-524-2120
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP199156213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist