Healthcare Provider Details

I. General information

NPI: 1306896972
Provider Name (Legal Business Name): DAVID W SANGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N PARK AVE
ELLINWOOD KS
67526-1452
US

IV. Provider business mailing address

300 N PARK AVE
ELLINWOOD KS
67526-1452
US

V. Phone/Fax

Practice location:
  • Phone: 620-564-3771
  • Fax: 620-564-2491
Mailing address:
  • Phone: 620-564-3771
  • Fax: 620-564-2491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04-29865
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: