MEDICARE: MARK A 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	177	WY

General Provider Information

NPI Number	:	1619018918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK A SANDERS PA-C

Provider Business Mailing Address
First Line	:	PO BOX 1359
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82902-1359
Country	:	US
Telephone Number	:	307-212-7708
Fax Number	:	307-352-8148

Provider Business Practice Location Address
First Line	:	3000 COLLEGE DR
Second Line	:
City	:	ROCK SPRINGS
State	:	WY
Zip	:	82901-4202
Country	:	US
Telephone Number	:	307-212-7708
Fax Number	:	307-352-8148

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

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	01/23/2020

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Directions to “ MARK A SANDERS PA-C” Practice Location

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