Healthcare Provider Details

I. General information

NPI: 1205522539
Provider Name (Legal Business Name): DREW SANDERSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 W UNIVERSITY AVE STE 101
GEORGETOWN TX
78626-5430
US

IV. Provider business mailing address

6210 E HWY 290
AUSTIN TX
78723-1098
US

V. Phone/Fax

Practice location:
  • Phone: 512-819-0264
  • Fax: 512-406-6242
Mailing address:
  • Phone: 512-483-9596
  • Fax: 512-406-6216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberW7123
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: