Individual
CLYDE FAGG SANFORD III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
E9970
TX
207RC0000X
Cardiovascular Disease Physician
Primary
E9970
TX
207RI0011X
Interventional Cardiology Physician
E9970
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
038665009
UNITED HEALTHCARE
TX
01
—
089421J
BCBS
TX
05
—
128834202
—
TX
05
—
128834206
—
TX
01
—
4538099
AETNA
TX
01
—
752616977007
TRICARE
TX
Enumeration date
09/13/2005
Last updated
07/08/2024
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