MEDICARE: MR. DAVID BRADFORD SANDERS JR. MS, CCP

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	242T00000X	Perfusionist

General Provider Information

NPI Number	:	1760620926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID BRADFORD SANDERS JR. MS, CCP

Provider Business Mailing Address
First Line	:	350 W. THOMAS RD
Second Line	:	ST. JOSEPH'S HOSPITAL AND MEDICAL CENTER ATTN: CATH LAB
City	:	PHOENIX
State	:	AZ
Zip	:	85013-0000
Country	:	US
Telephone Number	:	602-406-5194
Fax Number	:	602-798-0311

Provider Business Practice Location Address
First Line	:	350 W. THOMAS RD.
Second Line	:	ST. JOSEPH'S HOSPITAL AND MEDICAL CENTER, ATTN: CATH LA
City	:	PHOENIX
State	:	AZ
Zip	:	85013-0000
Country	:	US
Telephone Number	:	602-406-5194
Fax Number	:	602-798-0311

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

Provider Enumeration Date	:	01/27/2009
Last Update Date	:	01/27/2009

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