Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0106X | Orthopaedic Hand Surgeon | 187115-1205 | UT |
N | 2082S0105X | Plastic Hand Surgeon | 187115-1205 | UT |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 187115-1205 | UT |
NPI | 1073604609 |
---|---|
Provider Name | Mark C Sanderson |
First Address | Provo, UT 84604-3305 |
Second Address | American Fork, UT 84003-2906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 30/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
107005288103 | IHC (01) | UT |
13-00081 | UNITED HEALTHCARE (01) | UT |
215832 | ALTIUS (01) | UT |
54270 | DMBA (01) | UT |
79371 | PEHP (01) | UT |
870281028000 | (05) | UT |
870281028SAN | EMIA (01) | UT |
E88678 | (02) | UT |
P00167990 | PALMETTO (01) | UT |