Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RG0100X | Gastroenterologist | F2434 | TX |
NPI | 1003808601 |
---|---|
Provider Name | Barry Sanders |
First Address | Lewisville, TX 75057-3629 |
Second Address | Lewisville, TX 75057-3629 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C21527 | (02) | TX |