Provider Demographics
NPI:1770805731
Name:SANDERS, SCOTT EDWARD
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:EDWARD
Last Name:SANDERS
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 1:5178 WESTDALE DR
Mailing Address - Street 2:APT 4
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-1865
Mailing Address - Country:US
Mailing Address - Phone:408-497-0968
Mailing Address - Fax:
Practice Address - Street 1:5178 WESTDALE DR
Practice Address - Street 2:APT 4
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-1865
Practice Address - Country:US
Practice Address - Phone:408-497-0968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians