Healthcare Provider Details

I. General information

NPI: 1376571620
Provider Name (Legal Business Name): MARK JASON SANDERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 RUCKER AVE
EVERETT WA
98203-2215
US

IV. Provider business mailing address

8609 EVERGREEN WAY
EVERETT WA
98208-2619
US

V. Phone/Fax

Practice location:
  • Phone: 425-382-4000
  • Fax: 425-382-4001
Mailing address:
  • Phone: 425-789-3789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00037227
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00037227
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: