Healthcare Provider Details

I. General information

NPI: 1710920137
Provider Name (Legal Business Name): MARC NEIL SANDERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 ROUND VALLEY DR STE 200
PARK CITY UT
84060-7552
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 435-658-7246
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number1700411205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: