Healthcare Provider Details

I. General information

NPI: 1699876268
Provider Name (Legal Business Name): JAMES C SANDERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 05/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3885 TAMPA RD SUITE B
OLDSMAR FL
34677-3121
US

IV. Provider business mailing address

PO BOX 1579
OLDSMAR FL
34677-1579
US

V. Phone/Fax

Practice location:
  • Phone: 813-925-3223
  • Fax: 813-925-0088
Mailing address:
  • Phone: 813-925-3223
  • Fax: 813-925-0088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME0064489
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: