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General NPI Number Information
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NPI Number | 1275630782
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Entity Type | Individual
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Provider Name | JOHN PETTEY SANDIFER MD
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Gender | Male
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Dates
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Enumeration Date | 09/19/2006
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Last Update Date | 01/18/2017
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Provider Practice Location Address
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Address Line | 213 SOUTH DRIVE
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City | NATCHITOCHES
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State | LA
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Zip | 71457
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Country | US
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Telephone | 318-352-6120
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Fax | 318-352-6061
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Provider Business Mailing Address
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Address Line | 3444 MASONIC DR
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City | ALEXANDRIA
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State | LA
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Zip | 71301-3615
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Country | US
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Telephone | 318-473-9556
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Fax | 318-441-8339
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 06233R
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License Number State | LA
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