Healthcare Provider Details

I. General information

NPI: 1285609198
Provider Name (Legal Business Name): TERRY ALAN SANDERS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 04/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 N KEENE ST SUITE 209
COLUMBIA MO
65201-6897
US

IV. Provider business mailing address

305 N KEENE ST SUITE 209
COLUMBIA MO
65201-6897
US

V. Phone/Fax

Practice location:
  • Phone: 573-443-2015
  • Fax: 573-449-5886
Mailing address:
  • Phone: 573-443-2015
  • Fax: 573-449-5886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number2007025473
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: