Provider Demographics
NPI:1841290178
Name:SANDERSON, J NATHANIEL (MD)
Entity type:Individual
Prefix:
First Name:J
Middle Name:NATHANIEL
Last Name:SANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2600
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78299-2600
Mailing Address - Country:US
Mailing Address - Phone:210-692-8811
Mailing Address - Fax:
Practice Address - Street 1:301 JUNCTION HWY
Practice Address - Street 2:STE 220
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-4247
Practice Address - Country:US
Practice Address - Phone:830-896-3730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0139207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83X625Medicare PIN