Provider Demographics
NPI:1194774042
Name:O'CONNOR-SANDERS, LYDIA E (DO)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:E
Last Name:O'CONNOR-SANDERS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4760 S PECOS RD
Mailing Address - Street 2:STE. 211
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-5828
Mailing Address - Country:US
Mailing Address - Phone:702-735-0355
Mailing Address - Fax:702-735-0067
Practice Address - Street 1:4760 S PECOS RD
Practice Address - Street 2:STE. 211
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5828
Practice Address - Country:US
Practice Address - Phone:702-735-0355
Practice Address - Fax:702-735-0067
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV913207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018172Medicaid
NVV40454Medicare ID - Type UnspecifiedNV MEDICARE
NV002018172Medicaid