=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013292317
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GEREMY L SANDERS MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2011
-----------------------------------------------------
Last Update Date | 01/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9010 BRODIE LN STE D-100
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78748-5186
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-329-5705
-----------------------------------------------------
Fax | 512-329-5720
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9010 BRODIE LN STE D-100
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78748-5186
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-329-5705
-----------------------------------------------------
Fax | 512-329-5720
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER OF PA
-----------------------------------------------------
Name | GEREMY L SANDERS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 512-329-5705
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208VP0014X
-----------------------------------------------------
Taxonomy Name | Interventional Pain Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------