Sanderson, Jody Lee

Sanderson, Jody Lee is an individual health care provider with primary practice located at 1111 E Mcdowell Rd , Phoenix AZ 85006-2612. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Sanderson, Jody Lee can be contacted via phone (602) 839-6968.

Contact Information

Primary practice address
1111 E Mcdowell Rd Phoenix AZ 85006-2612
Phone: (602) 839-6968
Fax: (602) 839-4144
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 2580 Arizona

Profile Details

NPI number 1164490579
LBN Legal business name Sanderson, Jody Lee
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 10th, 2006
Last updated Jul 29th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164490579 NPPES
Arizona MEDICAID 649692

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