| Doctor Name: | ALEX JONATHAN SANDERSON |
| NPI Number: | 1104854967 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PAC |
| License Number: | |
| Business Practice Address: | 307 East Wardell Drive Pembroke, NC - 28372 |
| Business Phone Number: | 9105212816 |
| Business Fax Number: | 9105213583 |
| Mailing Address: | 307 East Wardell Drive, PEMBROKE |
| State: | NC |
| Postal Code: | 28372 |
| Phone Number: | 9105212816 |
| Fax Number: | 9105213583 |
| NPI Enumeration Date: | 06/29/2006 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |