Provider Demographics
NPI:1952763781
Name:SANDER, TOBY
Entity Type:Individual
Prefix:
First Name:TOBY
Middle Name:
Last Name:SANDER
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 1:2635 SEVEN OAKS PARK
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-8005
Mailing Address - Country:US
Mailing Address - Phone:563-940-5997
Mailing Address - Fax:
Practice Address - Street 1:2635 SEVEN OAKS PARK
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-8005
Practice Address - Country:US
Practice Address - Phone:563-940-5997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA719YY2488343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)