Healthcare Provider Details

I. General information

NPI: 1801803853
Provider Name (Legal Business Name): JOHN CARL SANDERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 04/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 BRADBURY DR SE STE 2222
ALBUQUERQUE NM
87106-4375
US

IV. Provider business mailing address

SHRINERS HOSPITALS FOR CHILDREN SALT DEPT 5034
LOS ANGELES CA
90084-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-1111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2000-101
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: