Healthcare Provider Details

I. General information

NPI: 1336285840
Provider Name (Legal Business Name): SANDER JAY GOTHARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5655 WEST SPRING CREEK PKWY SUITE 200
PLANO TX
75024
US

IV. Provider business mailing address

5655 WEST SPRING CREEK PKWY SUITE 200
PLANO TX
75024
US

V. Phone/Fax

Practice location:
  • Phone: 972-599-9600
  • Fax: 972-599-9696
Mailing address:
  • Phone: 972-599-9600
  • Fax: 972-599-9696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberK1202
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: