Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 082019 | NM |
Y | 111NI0900X | Internist | 082019 | NM |
N | 208D00000X | General Practice Physician | 15602 | FL |
NPI | 1013445329 |
---|---|
Provider Name | Dr Justin Lanier Sanders |
First Address | Las Cruces, NM 88011-8255 |
Second Address | Las Cruces, NM 88011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2017 |
Last Update Date | 10/09/2020 |