MEDICARE: JENNIFER M SANDERFORD MD

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	208000000X	Pediatrics Physician	38507	CO

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	:	1750382149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER M SANDERFORD MD

Provider Business Mailing Address
First Line	:	PO BOX 167
Second Line	:
City	:	CRESTED BUTTE
State	:	CO
Zip	:	81224-0167
Country	:	US
Telephone Number	:	970-349-3333
Fax Number	:	844-278-8636

Provider Business Practice Location Address
First Line	:	419 6TH STREET
Second Line	:	SUITE 202
City	:	CRESTED BUTTE
State	:	CA
Zip	:	81224
Country	:	US
Telephone Number	:	970-349-3333
Fax Number	:	844-278-8636

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	03/27/2018

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