Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 12279 | TN |
NPI | 1174714703 |
---|---|
Provider Name | Dan S Sanders III |
First Address | Skyland, NC 28776-2315 |
Second Address | Nashville, TN 37203-2131 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2007 |
Last Update Date | 16/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
103I032230 | MEDICARE PTAN (01) | TN |