Provider Demographics
NPI:1588743793
Name:SANDERS, JOHN T (DPM)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:T
Last Name:SANDERS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3430 NEWBURG RD
Mailing Address - Street 2:STE 153
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218
Mailing Address - Country:US
Mailing Address - Phone:502-459-8127
Mailing Address - Fax:502-459-8620
Practice Address - Street 1:3430 NEWBURG RD
Practice Address - Street 2:STE 153
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218
Practice Address - Country:US
Practice Address - Phone:502-459-8127
Practice Address - Fax:502-459-8620
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY153213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY80001530Medicaid
0976701Medicare ID - Type Unspecified
KY80001530Medicaid