MEDICARE: DR. MARK R SANDS DPM

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	1076	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00174690	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0004328912	OTHER	TX	AETNA PROVIDER ID
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	8M1220	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1386646339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK R SANDS DPM

Provider Business Mailing Address
First Line	:	PO BOX 4572
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77210-4572
Country	:	US
Telephone Number	:	281-996-9546
Fax Number	:	281-996-7645

Provider Business Practice Location Address
First Line	:	119 E EDGEWOOD DR
Second Line	:
City	:	FRIENDSWOOD
State	:	TX
Zip	:	77546-3818
Country	:	US
Telephone Number	:	281-996-9546
Fax Number	:	281-996-7645

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

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	01/16/2008

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Directions to “ DR. MARK R SANDS DPM” Practice Location

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