Individual
BILLY GRANT SANDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
15679 NE 23RD ST, CHOCTAW, OK 73020-8592
(405) 390-9600
Mailing address
PO BOX 10, CHOCTAW, OK 73020-0010
(405) 390-9600
(405) 390-9400
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1561
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200100040A
—
OK
01
—
OK400905
MEDICARE INDIVIDUAL PTAN
—
Enumeration date
11/21/2006
Last updated
09/21/2025
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