Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | ME62847 | FL |
NPI | 1033112255 |
---|---|
Provider Name | Dr. Charles E Sanders JR. |
First Address | Tampa, FL 33606-2707 |
Second Address | Temple Terrace, FL 33637-0935 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 25/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
18235X | MEDICARE PTAN (01) | FL |
371667800 | (05) | FL |
B65461 | (02) | |
B65461 | (02) | FL |