MEDICARE: BENJAMIN L SANDERS M.D.

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	207Q00000X	Family Medicine Physician	MD00040114	WA

General Provider Information

NPI Number	:	1942298021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN L SANDERS M.D.

Provider Business Mailing Address
First Line	:	4312 WOODLAWN AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-7523
Country	:	US
Telephone Number	:	206-632-2420
Fax Number	:

Provider Business Practice Location Address
First Line	:	4312 WOODLAWN AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-7523
Country	:	US
Telephone Number	:	206-632-2420
Fax Number	:

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	11/01/2012

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