Provider Demographics
NPI:1720494669
Name:SANFORD, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:SANFORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 LONG PRAIRIE RD
Mailing Address - Street 2:107-824
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-4832
Mailing Address - Country:US
Mailing Address - Phone:972-914-9447
Mailing Address - Fax:
Practice Address - Street 1:2605 SAGEBRUSH DR
Practice Address - Street 2:SUITE 105
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2761
Practice Address - Country:US
Practice Address - Phone:972-914-9447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist