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General NPI Number Information
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NPI Number | 1275757015
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Entity Type | Organization
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Legal Business Name | E. WAYNE SANDERS, JR. MD, INC.
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3706 TELEGRAPH AVE
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City | OAKLAND
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State | CA
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Zip | 94609-2418
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Country | US
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Telephone | 510-375-2836
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Fax | 510-653-7159
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Provider Business Mailing Address
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Address Line | PO BOX 2270
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City | SAUSALITO
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State | CA
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Zip | 94966-2270
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Country | US
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Telephone | 510-331-2788
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Fax | 510-653-7159
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Authorized Official
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Title or Position | PRESIDENT
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Name | EDWARD SANDERS
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Credential | MD
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Telephone | 510-375-2836
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | C29998
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License Number State | CA
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