MEDICARE: DR. ROBERT V SANDERS III 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	207R00000X	Internal Medicine Physician	R-4401	AR

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
3	55965	OTHER	AR	AR BCBS
4	P00349187	OTHER	AR	RR MCR

General Provider Information

NPI Number	:	1881616092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT V SANDERS III MD

Provider Business Mailing Address
First Line	:	600 MEMORIAL DR
Second Line	:
City	:	BELLA VISTA
State	:	AR
Zip	:	72714-1847
Country	:	US
Telephone Number	:	479-855-6165
Fax Number	:	479-855-2831

Provider Business Practice Location Address
First Line	:	600 MEMORIAL DR
Second Line	:
City	:	BELLA VISTA
State	:	AR
Zip	:	72714-1847
Country	:	US
Telephone Number	:	479-855-6165
Fax Number	:	479-855-2831

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	03/12/2018

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