MEDICARE: LAWRENCE W SANDERS M.D.

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	207Q00000X	Family Medicine Physician	G5568	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8510M2	OTHER		BCBS OF TX PROVIDER #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164421103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE W SANDERS M.D.

Provider Business Mailing Address
First Line	:	2200 HIGHWAY 365
Second Line	:
City	:	NEDERLAND
State	:	TX
Zip	:	77627-5506
Country	:	US
Telephone Number	:	409-722-4321
Fax Number	:	409-729-2332

Provider Business Practice Location Address
First Line	:	1801 S GULFWAY DR
Second Line	:
City	:	PORT ARTHUR
State	:	TX
Zip	:	77640-4416
Country	:	US
Telephone Number	:	409-985-1819
Fax Number	:	409-985-1079

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	01/05/2025

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