Healthcare Provider Details

I. General information

NPI: 1699262733
Provider Name (Legal Business Name): JOHN DAVID SANDERSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2018
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7243 DELLA DR STE I
ORLANDO FL
32819-5126
US

IV. Provider business mailing address

7243 DELLA DR STE I
ORLANDO FL
32819-5126
US

V. Phone/Fax

Practice location:
  • Phone: 321-843-5851
  • Fax: 321-842-0089
Mailing address:
  • Phone: 321-843-5851
  • Fax: 321-842-0089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberOS16376
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: