Healthcare Provider Details

I. General information

NPI: 1164407136
Provider Name (Legal Business Name): WILLIAM R SANDERSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 03/25/2020
Certification Date: 03/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEMORIAL HOSPITAL DR STE 2A
MOBILE AL
36608-1199
US

IV. Provider business mailing address

3719 DAUPHIN ST SUITE 100
MOBILE AL
36608-1753
US

V. Phone/Fax

Practice location:
  • Phone: 251-343-9090
  • Fax: 251-380-1015
Mailing address:
  • Phone: 251-343-9090
  • Fax: 251-380-1015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number18054
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: