MEDICARE: DR. ALAN R. SANDIDGE 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	207Q00000X	Family Medicine Physician	2002003294	MO

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	:	1427025295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN R. SANDIDGE M.D.

Provider Business Mailing Address
First Line	:	3619 RICHARDSON SQUARE DR
Second Line	:	SUITE 170
City	:	ARNOLD
State	:	MO
Zip	:	63010
Country	:	US
Telephone Number	:	636-717-6776
Fax Number	:	314-525-4055

Provider Business Practice Location Address
First Line	:	3619 RICHARDSON SQUARE DR
Second Line	:	SUITE 170
City	:	ARNOLD
State	:	MO
Zip	:	63010
Country	:	US
Telephone Number	:	636-717-6776
Fax Number	:	314-525-4055

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

Provider Enumeration Date	:	03/01/2006
Last Update Date	:	06/07/2010

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