Individual
MR. JODY LEE SANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1111 E MCDOWELL RD, PHOENIX, AZ 85006-2612
(602) 839-6968
(602) 839-4144
Mailing address
PO BOX 15070, SCOTTSDALE, AZ 85267-5070
(480) 421-9700
(480) 421-9899
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
2580
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
649692
—
AZ
Enumeration date
03/10/2006
Last updated
07/29/2014
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