Healthcare Provider Details

I. General information

NPI: 1821228396
Provider Name (Legal Business Name): TODD SANDERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2009
Last Update Date: 04/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 N E ST SUITE 300
PENSACOLA FL
32501-6339
US

IV. Provider business mailing address

475 JAMES RIVER RD
GULF BREEZE FL
32561-4868
US

V. Phone/Fax

Practice location:
  • Phone: 850-432-6851
  • Fax:
Mailing address:
  • Phone: 850-445-6606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME 123484
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: