Individual
TIFFANY SANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A
Contact information
Practice address
3600 GASTON AVE, SUITE 907, DALLAS, TX 75246-1800
(214) 823-2052
(214) 823-5747
Mailing address
3600 GASTON AVE, SUITE 907, DALLAS, TX 75246-1800
(214) 823-2052
(214) 823-5747
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA04848
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA04848
PA LICENSE
TX
Enumeration date
09/14/2006
Last updated
07/08/2007
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