Provider Demographics
NPI:1124052121
Name:BROTHERS, SANDRA ZOE (MD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:ZOE
Last Name:BROTHERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 N WASHINGTON AVE
Mailing Address - Street 2:SUITE 2700
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1713
Mailing Address - Country:US
Mailing Address - Phone:214-823-7900
Mailing Address - Fax:214-239-4260
Practice Address - Street 1:411 N WASHINGTON AVE
Practice Address - Street 2:SUITE 2700
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1713
Practice Address - Country:US
Practice Address - Phone:214-823-7900
Practice Address - Fax:214-239-4260
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8475207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AJ518OtherBC/BS SOLO IDENTIFIER
TX160052816OtherRAIL ROAD MEDICARE
TX143857402Medicaid
TX160052816OtherRAIL ROAD MEDICARE
TX00683MMedicare PIN