MEDICARE: MITCHELL ADAM SANFORD

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	29354	MS

General Provider Information

NPI Number	:	1346726098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL ADAM SANFORD

Provider Business Mailing Address
First Line	:	6101 BLUE LAGOON DR STE 200
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33126-3168
Country	:	US
Telephone Number	:	305-500-2000
Fax Number	:	786-522-9018

Provider Business Practice Location Address
First Line	:	12057 HIGHWAY 49 STE C
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39503-3177
Country	:	US
Telephone Number	:	228-832-9385
Fax Number	:	888-498-3529

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

Provider Enumeration Date	:	07/16/2018
Last Update Date	:	03/31/2026

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