MEDICARE: SANDRA V ARCHER 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	207V00000X	Obstetrics & Gynecology Physician	L2106	TX
2	207V00000X	Obstetrics & Gynecology Physician	7359472-1205	UT

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356319842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA V ARCHER MD

Provider Business Mailing Address
First Line	:	1055 N 300 W
Second Line	:	SUITE 110
City	:	PROVO
State	:	UT
Zip	:	84604-3344
Country	:	US
Telephone Number	:	801-357-7377
Fax Number	:	801-357-7377

Provider Business Practice Location Address
First Line	:	1055 N 300 W
Second Line	:	SUITE 110
City	:	PROVO
State	:	UT
Zip	:	84604-3344
Country	:	US
Telephone Number	:	801-357-7377
Fax Number	:	801-357-7377

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	07/18/2014

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Directions to “ SANDRA V ARCHER MD” Practice Location

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