Healthcare Provider Details

I. General information

NPI: 1780782367
Provider Name (Legal Business Name): CARY TODD SANDERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 PONDEROSA DR
SUTHERLIN OR
97479-9812
US

IV. Provider business mailing address

123 PONDEROSA DR
SUTHERLIN OR
97479-9812
US

V. Phone/Fax

Practice location:
  • Phone: 541-391-8155
  • Fax: 541-391-8154
Mailing address:
  • Phone: 541-391-8155
  • Fax: 541-391-8154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD172332
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: