Healthcare Provider Details

I. General information

NPI: 1396783411
Provider Name (Legal Business Name): SANFORD ARCHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 SOUTH LIMESTONE
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

2333 ALUMNI PARK PLZ SUITE200
LEXINGTON KY
40517-4012
US

V. Phone/Fax

Practice location:
  • Phone: 859-257-5405
  • Fax:
Mailing address:
  • Phone: 859-218-5677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number26127
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: