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General NPI Number Information
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NPI Number | 1871918342
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Entity Type | Organization
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Legal Business Name | KENNETH W. SANDERS, MD LLC
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Dates
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Enumeration Date | 02/20/2014
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Last Update Date | 02/20/2014
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Provider Practice Location Address
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Address Line | 1811 EAST BERT KOUNS SUITE 160
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City | SHREVEPORT
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State | LA
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Zip | 71105
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Country | US
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Telephone | 318-212-3223
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Fax | 318-212-3989
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Provider Business Mailing Address
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Address Line | 1811 EAST BERT KOUNS SUITE 160
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City | SHREVEPORT
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State | LA
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Zip | 71105
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Country | US
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Telephone | 318-212-3223
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Fax | 318-212-3989
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Authorized Official
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Title or Position | MD
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Name | KENNETH W. SANDERS
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Credential | MD
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Telephone | 318-469-1956
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YS0012X
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Taxonomy Name | Sleep Medicine (Otolaryngology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number |
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License Number State |
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