MEDICARE: LYDIA E O'CONNOR-SANDERS DO

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	207Q00000X	Family Medicine Physician	913	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194774042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYDIA E O'CONNOR-SANDERS DO

Provider Business Mailing Address
First Line	:	4760 S PECOS RD
Second Line	:	STE. 211
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5828
Country	:	US
Telephone Number	:	702-735-0355
Fax Number	:	702-735-0067

Provider Business Practice Location Address
First Line	:	4760 S PECOS RD
Second Line	:	STE. 211
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-5828
Country	:	US
Telephone Number	:	702-735-0355
Fax Number	:	702-735-0067

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	04/04/2008

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