Healthcare Provider Details

I. General information

NPI: 1306815626
Provider Name (Legal Business Name): SCOTT MITCHELL SANDERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S UNIVERSITY AVE SUITE 200
LITTLE ROCK AR
72205-5302
US

IV. Provider business mailing address

500 S. UNIVERSITY SUITE 200
LITTLE ROCK AR
72205
US

V. Phone/Fax

Practice location:
  • Phone: 501-664-4117
  • Fax: 501-664-1137
Mailing address:
  • Phone: 501-664-4117
  • Fax: 501-664-1137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-1901
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: