Provider Demographics
NPI:1194705376
Name:SANDERS, GILBERT OTIS (EDD)
Entity type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:OTIS
Last Name:SANDERS
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 454 BOX 2197
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09250
Mailing Address - Country:US
Mailing Address - Phone:49-981-9720
Mailing Address - Fax:
Practice Address - Street 1:USAMEDDAC WUERZBURG
Practice Address - Street 2:US ARMY HEALTH CLINIC KATTERBACH, UNIT 28614,
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09250
Practice Address - Country:US
Practice Address - Phone:49-980-2883
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK585103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN