MEDICARE: JOHN D SADLER CLINICAL CHEMIST

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
1	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician	45D2154841	TX

General Provider Information

NPI Number	:	1043808264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN D SADLER CLINICAL CHEMIST

Provider Business Mailing Address
First Line	:	4106 TIDEWATER DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77045-4338
Country	:	US
Telephone Number	:	713-517-1875
Fax Number	:

Provider Business Practice Location Address
First Line	:	4106 TIDEWATER DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77045-4338
Country	:	US
Telephone Number	:	713-517-1875
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2021
Last Update Date	:	01/04/2021

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