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General NPI Number Information
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NPI Number | 1164597860
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Entity Type | Individual
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Provider Name | BILLY GRANT SANDERS PA
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Gender | Male
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 09/21/2025
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Provider Practice Location Address
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Address Line | 15679 NE 23RD ST
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City | CHOCTAW
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State | OK
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Zip | 73020-8592
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Country | US
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Telephone | 405-390-9600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10
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City | CHOCTAW
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State | OK
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Zip | 73020-0010
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Country | US
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Telephone | 405-390-9600
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Fax | 405-390-9400
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1561
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License Number State | OK
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