MEDICARE: SANDERS PODIATRY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist

General Provider Information

NPI Number	:	1083239636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDERS PODIATRY LLC

Provider Business Mailing Address
First Line	:	2830 10TH ST
Second Line	:
City	:	BAKER CITY
State	:	OR
Zip	:	97814-1404
Country	:	US
Telephone Number	:	541-524-0122
Fax Number	:

Provider Business Practice Location Address
First Line	:	2830 10TH ST
Second Line	:
City	:	BAKER CITY
State	:	OR
Zip	:	97814-1404
Country	:	US
Telephone Number	:	541-524-0122
Fax Number	:

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. BRIAN SANDERS
Credential	:	DPM
Telephone Number	:	541-524-0122

Provider Enumeration Date	:	06/10/2020
Last Update Date	:	06/10/2020

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