Individual
KENNETH WAYNE SANDERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8711 LINE AVE, SHREVEPORT, LA 71106-6813
(318) 698-8711
(318) 988-6766
Mailing address
1811 E BERT KOUNS INDUSTRIAL LOOP, SUITE 160, SHREVEPORT, LA 71105-5740
(318) 212-3223
(318) 212-3989
Taxonomy
Speciality
Code
Description
License number
State
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
Primary
022757
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1686735
—
LA
Enumeration date
07/06/2006
Last updated
09/30/2019
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