Provider Demographics
NPI:1699876268
Name:SANDERSON, JAMES C (MD)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:C
Last Name:SANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1579
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-1579
Mailing Address - Country:US
Mailing Address - Phone:813-925-3223
Mailing Address - Fax:813-925-0088
Practice Address - Street 1:3885 TAMPA RD
Practice Address - Street 2:SUITE B
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-3121
Practice Address - Country:US
Practice Address - Phone:813-925-3223
Practice Address - Fax:813-925-0088
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0064489207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E56714Medicare UPIN
FL23277AMedicare ID - Type Unspecified