Healthcare Provider Details

I. General information

NPI: 1235189044
Provider Name (Legal Business Name): HAROLD LOYD SANDROCK JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1296 TOD PL NW
WARREN OH
44485-2474
US

IV. Provider business mailing address

366 INGRAM DR
BOARDMAN OH
44512-5856
US

V. Phone/Fax

Practice location:
  • Phone: 330-306-5030
  • Fax:
Mailing address:
  • Phone: 330-758-8772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34-00-2386-S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: