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General NPI Number Information
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NPI Number | 1043577448
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Entity Type | Individual
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Provider Name | DERRICK J SANDERSON
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Gender | Male
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Dates
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Enumeration Date | 04/23/2012
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 1122 W HIGHWAY 61
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City | WINONA
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State | MN
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Zip | 55987-1957
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Country | US
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Telephone | 608-782-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 1836 SOUTH AVE
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City | LA CROSSE
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State | WI
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Zip | 54601-5429
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Country | US
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Telephone | 608-782-7300
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 283330
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207VF0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
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License Number | 02005887A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207VF0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
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License Number | 81662
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License Number State | WI
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