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1700861861

NPI Code Detail

MEDICARE: ELIZABETH GRACE SANFORD MD

MEDICARE: ELIZABETH GRACE SANFORD 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	MD00022365	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	G8895320	OTHER	WA	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SA4585	OTHER		REGENCE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0270550	OTHER	WA	L&I

General Provider Information

NPI Number	:	1700861861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH GRACE SANFORD MD

Provider Business Mailing Address
First Line	:	315 MARTIN LUTHER KING JR WAY
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98405-4234
Country	:	US
Telephone Number	:	253-403-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	315 MARTIN LUTHER KING JR WAY
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98405-4234
Country	:	US
Telephone Number	:	253-403-1000
Fax Number	:

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

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	02/26/2016

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Directions to “ ELIZABETH GRACE SANFORD MD” Practice Location

Language	Start Address	Practice Location

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