Basic Information
| Provider Information | |||||||||
| NPI: | 1679078703 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANDERS | ||||||||
| FirstName: | GAYLEN | ||||||||
| MiddleName: | PATTERSON | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 415 S 28TH AVE | ||||||||
| Address2: | |||||||||
| City: | HATTIESBURG | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394017283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6015793000 | ||||||||
| FaxNumber: | 6015795240 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 MEDICAL PARK | ||||||||
| Address2: | |||||||||
| City: | HATTIESBURG | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394019042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6015793000 | ||||||||
| FaxNumber: | 6015795240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2018 | ||||||||
| LastUpdateDate: | 08/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | T-3649 | MS | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 29017 | MS | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.