Individual
DERRICK J SANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1122 W HIGHWAY 61, WINONA, MN 55987-1957
(608) 782-7300
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
283330
NY
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
02005887A
IN
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
Primary
81662
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300038901
—
IN
05
—
7100666260
—
KY
Enumeration date
04/23/2012
Last updated
11/08/2024
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