MEDICARE: DR. RILEY N SANDERS 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	207WX0107X	Retina Specialist (Ophthalmology) Physician	E13044	AR
2	390200000X	Student in an Organized Health Care Education/Training Program	E-13044	AR
3	207W00000X	Ophthalmology Physician	E-13044	AR

General Provider Information

NPI Number	:	1790147155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RILEY N SANDERS MD

Provider Business Mailing Address
First Line	:	924 MAIN ST
Second Line	:
City	:	CONWAY
State	:	AR
Zip	:	72032-5424
Country	:	US
Telephone Number	:	501-327-4444
Fax Number	:	501-327-4639

Provider Business Practice Location Address
First Line	:	9800 BAPTIST HEALTH DR STE 501
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-6243
Country	:	US
Telephone Number	:	501-223-8400
Fax Number	:	501-223-3713

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

Provider Enumeration Date	:	03/24/2016
Last Update Date	:	07/11/2023

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