Healthcare Provider Details

I. General information

NPI: 1104027119
Provider Name (Legal Business Name): DONALD SANDERS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 MOHAWK DR
BOULDER CO
80303-3712
US

IV. Provider business mailing address

369 WHISPERING PNES
BOULDER CO
80302-9791
US

V. Phone/Fax

Practice location:
  • Phone: 303-743-5855
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208U00000X
TaxonomyClinical Pharmacology Physician
License Number13822
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: