Individual
LAYNE C. SANDRIDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
18700 N 64TH DR STE 105A, GLENDALE, AZ 85308-7110
(623) 688-5075
(623) 688-5075
Mailing address
19801 N 59TH AVE UNIT 11659, GLENDALE, AZ 85318-5068
(623) 688-5075
(623) 688-5075
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
40861
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
398159
—
AZ
01
—
Z216660
MEDICARE
AZ
Enumeration date
05/09/2008
Last updated
01/04/2019
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