MEDICARE: DR. MARK SALAVAS SANDERS M.D.

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	174400000X	Specialist	200500896	NC

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	:	1265495303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK SALAVAS SANDERS M.D.

Provider Business Mailing Address
First Line	:	417 NORTHCREST DR
Second Line	:
City	:	SPRINGFIELD
State	:	TN
Zip	:	37172-3973
Country	:	US
Telephone Number	:	615-384-8211
Fax Number	:	615-384-5859

Provider Business Practice Location Address
First Line	:	417 NORTHCREST DR
Second Line	:
City	:	SPRINGFIELD
State	:	TN
Zip	:	37172-3973
Country	:	US
Telephone Number	:	615-384-8211
Fax Number	:	615-384-5859

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	08/14/2012

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