Healthcare Provider Details

I. General information

NPI: 1700863263
Provider Name (Legal Business Name): JAMES EDWARD SANDERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 S 4TH ST
LEAVENWORTH KS
66048-5014
US

IV. Provider business mailing address

1201 WALNUT ST SUITE 800
KANSAS CITY MO
64106-2149
US

V. Phone/Fax

Practice location:
  • Phone: 913-682-2000
  • Fax: 913-758-4225
Mailing address:
  • Phone: 816-701-3000
  • Fax: 816-221-0930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number21937
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: