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NPI Code Detail

MEDICARE: JEFFREY STEWART SANDERS M.D.

MEDICARE: JEFFREY STEWART 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
1207RC0000XCardiovascular Disease PhysicianR5J50MO

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1110045598OTHERMORAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407843139
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY STEWART SANDERS M.D.
Provider Business Mailing Address
First Line : 3501 A WEST TRUMAN BLVD.
Second Line :
City : JEFFERSON CITY
State : MO
Zip : 65109
Country : US
Telephone Number : 573-636-0635
Fax Number : 573-659-4685
Provider Business Practice Location Address
First Line : 3501 A WEST TRUMAN BLVD.
Second Line :
City : JEFFERSON CITY
State : MO
Zip : 65109
Country : US
Telephone Number : 573-636-0635
Fax Number : 573-659-4685
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2005
Last Update Date : 06/17/2009

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