Provider Demographics
NPI:1780785352
Name:JAMES C SANDERSON MD LLC
Entity type:Organization
Organization Name:JAMES C SANDERSON MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:SANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-925-3223
Mailing Address - Street 1:PO BOX 1579
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-1579
Mailing Address - Country:US
Mailing Address - Phone:813-925-3223
Mailing Address - Fax:813-925-0088
Practice Address - Street 1:3885 TAMPA RD
Practice Address - Street 2:SUITE B
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-3121
Practice Address - Country:US
Practice Address - Phone:813-925-3223
Practice Address - Fax:813-925-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23277AMedicare ID - Type Unspecified
E56714Medicare UPIN