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NPI Code Detail

MEDICARE: MATTHEW F SANFORD MD

MEDICARE: MATTHEW F SANFORD MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician49607MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033167416
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW F SANFORD MD
Provider Business Mailing Address
First Line : 1233 34TH ST NW
Second Line :
City : BEMIDJI
State : MN
Zip : 56601-5112
Country : US
Telephone Number : 218-333-5283
Fax Number :
Provider Business Practice Location Address
First Line : 1233 34TH ST NW
Second Line :
City : BEMIDJI
State : MN
Zip : 56601-5112
Country : US
Telephone Number : 218-333-5283
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2006
Last Update Date : 08/06/2012

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Directions to “ MATTHEW F SANFORD MD” Practice Location

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