Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204F00000X | Transplant Surgeon | 036137480 | IL |
Y | 2086S0129X | Vascular Surgeon | ME137773 | FL |
NPI | 1477871218 |
---|---|
Provider Name | Matthew Sanders |
First Address | Pensacola, FL 32524-1982 |
Second Address | Pensacola, FL 32504-8734 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2010 |
Last Update Date | 16/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104277800 | (05) | FL |