Provider Demographics
NPI:1285740951
Name:DAVID G. SANFORD, M.D., P.S.C.
Entity type:Organization
Organization Name:DAVID G. SANFORD, M.D., P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:SANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-248-0932
Mailing Address - Street 1:1502 CUMBERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965-1223
Mailing Address - Country:US
Mailing Address - Phone:606-248-0932
Mailing Address - Fax:606-248-1384
Practice Address - Street 1:1502 CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965-1223
Practice Address - Country:US
Practice Address - Phone:606-248-0932
Practice Address - Fax:606-248-1384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2016-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65945487Medicaid
KY000000284679OtherANTHEM GROUP NUMBER
KY000000284679OtherANTHEM GROUP NUMBER
4758140001Medicare NSC