Healthcare Provider Details

I. General information

NPI: 1164421103
Provider Name (Legal Business Name): LAWRENCE W SANDERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 01/05/2025
Certification Date: 01/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 S GULFWAY DR
PORT ARTHUR TX
77640-4416
US

IV. Provider business mailing address

2200 HIGHWAY 365
NEDERLAND TX
77627-5506
US

V. Phone/Fax

Practice location:
  • Phone: 409-985-1819
  • Fax: 409-985-1079
Mailing address:
  • Phone: 409-722-4321
  • Fax: 409-729-2332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG5568
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: