Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CH7177 | FL |
NPI | 1538349972 |
---|---|
Provider Name | Dr. David Ross Sanders |
First Address | Indian Harbour Beach, FL 32937-4930 |
Second Address | Indian Harbour Beach, FL 32937-4930 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2007 |
Last Update Date | 12/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
55574 | BCBS (01) | FL |
U67125 | (02) |