Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 0000039408 | TN |
Y | 207PP0204X | Pediatric Emergency Physician | N9292 | TX |
NPI | 1528084019 |
---|---|
Provider Name | Dr. Virginia M. Sanders |
First Address | San Antonio, TX 78229-5900 |
Second Address | San Antonio, TX 78229-5900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2006 |
Last Update Date | 18/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3327593 | (05) | TN |
4113629 | BLUE CROSS (01) | TN |
PENDING | (05) | TX |
PENDING | BCBS (01) | TX |