Basic Information
| Provider Information | |||||||||
| NPI: | 1184717803 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANDERS | ||||||||
| FirstName: | JOANN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 99371 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761990371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6828851855 | ||||||||
| FaxNumber: | 6828857347 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 COOPER ST | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761042710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6828854007 | ||||||||
| FaxNumber: | 6828854004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 04/20/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0207X | H5623 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology |
ID Information
| ID | Type | State | Issuer | Description | 3108280 | 01 | TX | CIGNA PIN | OTHER | 137345808 | 05 | TX | MEDICAID | 4133086 | 01 | TX | AETNA PIN | OTHER | 134733808 | 05 | TX | MEDICAID | 526517 | 01 | TX | FIRSTHEALTH PIN | OTHER | 81X461 | 01 | TX | BCBSTX IND PIN | OTHER | 10028772 | 01 | TX | AMERIGROUP PIN | OTHER | 123213101 | 01 | TX | FIRSTCARE PIN | OTHER | 60270 | 01 | TX | UHC PIN | OTHER | 00U87Z | 01 | TX | BCBSTX GRP PIN | OTHER | 083880701 | 05 | TX | MEDICAID | 124185 | 01 | TX | SUPERIOR PIN | OTHER |