Doctor Name: | EDWARD SANDERS |
NPI Number: | 1790909588 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | C29998 |
Business Practice Address: | 3706 Telegraph Ave Oakland, CA - 946092418 |
Business Phone Number: | 5103312788 |
Business Fax Number: | 5106537159 |
Mailing Address: | Po Box 2270, SAUSALITO |
State: | CA |
Postal Code: | 949662270 |
Phone Number: | 5103752836 |
Fax Number: | 5106537159 |
NPI Enumeration Date: | 04/12/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | C29998 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |