Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 283330 | NY |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 02005887A | IN |
NPI | 1043577448 |
---|---|
Provider Name | Derrick J Sanderson |
First Address | Newburgh, IN 47630-7909 |
Second Address | Newburgh, IN 47630-7909 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2012 |
Last Update Date | 27/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
300038901 | (05) | IN |
7100666260 | (05) | KY |