MEDICARE: DR. CODY JAMES SANDERSON 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
1	207X00000X	Orthopaedic Surgery Physician	342231	LA
2	207XP3100X	Pediatric Orthopaedic Surgery Physician	2022010832	MO

Other Identifiers

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

General Provider Information

NPI Number	:	1275064560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CODY JAMES SANDERSON MD

Provider Business Mailing Address
First Line	:	1541 KINGS HWY
Second Line	:	ATTN: PAYOR CREDENTIALING
City	:	SHREVEPORT
State	:	LA
Zip	:	71103-4228
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1541 KINGS HWY
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71103-4228
Country	:	US
Telephone Number	:	318-626-0000
Fax Number	:

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

Provider Enumeration Date	:	03/27/2017
Last Update Date	:	02/06/2026

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