Provider Demographics
NPI:1306137526
Name:SAUNDERS, JERRY ALLEN (MD)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:ALLEN
Last Name:SAUNDERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6010 E WT HARRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-4084
Mailing Address - Country:US
Mailing Address - Phone:704-208-4134
Mailing Address - Fax:704-316-5640
Practice Address - Street 1:9835 MONROE ROAD
Practice Address - Street 2:STE A
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-1471
Practice Address - Country:US
Practice Address - Phone:704-537-0909
Practice Address - Fax:704-537-0947
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2022-06-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC2015-00670207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1306137526Medicaid
NCNCP365AMedicare UPIN