MEDICARE: DALLAS R SANDERS PA-C

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	363AM0700X	Medical Physician Assistant	001546	IA
2	363AM0700X	Medical Physician Assistant	01546	IA

General Provider Information

NPI Number	:	1548316284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALLAS R SANDERS PA-C

Provider Business Mailing Address
First Line	:	PO BOX 1475
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50305-1475
Country	:	US
Telephone Number	:	515-643-5700
Fax Number	:	515-643-5739

Provider Business Practice Location Address
First Line	:	1350 DES MOINES ST STE 100
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50309-5507
Country	:	US
Telephone Number	:	515-643-5700
Fax Number	:	515-643-5739

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

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	01/17/2023

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Directions to “ DALLAS R SANDERS PA-C” Practice Location

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