Healthcare Provider Details

I. General information

NPI: 1023481090
Provider Name (Legal Business Name): RICHARD SANDERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2015
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 BEDFORD FOREST CT
OLD HICKORY TN
37138-1006
US

IV. Provider business mailing address

611 BEDFORD FOREST CT
OLD HICKORY TN
37138-1006
US

V. Phone/Fax

Practice location:
  • Phone: 615-541-4281
  • Fax:
Mailing address:
  • Phone: 615-541-4281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD 8323
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: