MEDICARE: BRENT C. 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	207Y00000X	Otolaryngology Physician	6754	AZ

General Provider Information

NPI Number	:	1790750297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENT C. SANDERS MD

Provider Business Mailing Address
First Line	:	2501 E SOUTHERN AVE
Second Line	:	20
City	:	TEMPE
State	:	AZ
Zip	:	85282-7669
Country	:	US
Telephone Number	:	480-969-3773
Fax Number	:	480-969-3031

Provider Business Practice Location Address
First Line	:	2501 E SOUTHERN AVE
Second Line	:	20
City	:	TEMPE
State	:	AZ
Zip	:	85282-7669
Country	:	US
Telephone Number	:	480-969-3773
Fax Number	:	480-969-3031

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

Provider Enumeration Date	:	02/20/2006
Last Update Date	:	07/08/2007

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