| Doctor Name: | BILLY GRANT SANDERS |
| NPI Number: | 1164597860 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | 1561 |
| Business Practice Address: | 15809 Ne 23rd St Choctaw, OK - 730208428 |
| Business Phone Number: | 4053909600 |
| Business Fax Number: | 4053909400 |
| Mailing Address: | Po Box 10, CHOCTAW |
| State: | OK |
| Postal Code: | 730200010 |
| Phone Number: | 4053909600 |
| Fax Number: | 4053909400 |
| NPI Enumeration Date: | 11/21/2006 |
| NPI Last Update Date: | 01/21/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 1561 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |