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General NPI Number Information
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NPI Number | 1053420323
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Entity Type | Organization
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Legal Business Name | JON E. SANFORD,M.D.,P.C.
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 122 17TH CT NE
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City | FAYETTE
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State | AL
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Zip | 35555-1353
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Country | US
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Telephone | 205-932-3900
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Fax | 205-932-3941
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Provider Business Mailing Address
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Address Line | 122 17TH CT NE
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City | FAYETTE
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State | AL
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Zip | 35555-1353
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Country | US
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Telephone | 205-932-3900
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Fax | 205-932-3941
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Authorized Official
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Title or Position | PRESIDENT
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Name | JON E SANFORD
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Credential | M.D.
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Telephone | 205-932-3900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 3835
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License Number State | AL
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