MEDICARE: DR. MARC R SANDERS M.D., P.A.

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	207W00000X	Ophthalmology Physician	J3593	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	180034605	OTHER	TX	MEDICARE RAILROAD

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	84920Y	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1508855529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC R SANDERS M.D., P.A.

Provider Business Mailing Address
First Line	:	3405 EDLOE ST
Second Line	:	SUITE 300
City	:	HOUSTON
State	:	TX
Zip	:	77027-6520
Country	:	US
Telephone Number	:	713-797-1500
Fax Number	:	713-797-1150

Provider Business Practice Location Address
First Line	:	3405 EDLOE ST
Second Line	:	SUITE 300
City	:	HOUSTON
State	:	TX
Zip	:	77027-6520
Country	:	US
Telephone Number	:	713-797-1500
Fax Number	:	713-797-1150

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	06/25/2010

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