Healthcare Provider Details

I. General information

NPI: 1700858891
Provider Name (Legal Business Name): MR. ALBERT GUY SANDERS III
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HOSPITAL, ENT DEPARTMENT 2080 CHILD STREET
JACKSONVILLE FL
32214-0001
US

IV. Provider business mailing address

2576 BOTTOMRIDGE DR
ORANGE PARK FL
32065-5793
US

V. Phone/Fax

Practice location:
  • Phone: 904-542-7048
  • Fax: 904-542-7467
Mailing address:
  • Phone: 904-542-7465
  • Fax: 904-542-7467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAY1058
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: