Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 2007025473 | MO |
NPI | 1285609198 |
---|---|
Provider Name | Terry Alan Sanders |
First Address | Columbia, MO 65201-6897 |
Second Address | Columbia, MO 65201-6897 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 15/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U74280 | (02) |