Individual
P COLLEEN SANDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
619 19TH STREET SOUTH, BIRMINGHAM, AL 35233
(205) 934-4011
Mailing address
PO BOX 55310, BIRMINGHAM, AL 35255-5310
(205) 731-9701
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
10577
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000016046
BLUE CROSS
AL
05
—
000016046
—
AL
05
—
009909395
—
AL
05
—
009979870
—
AL
01
—
010033CC76277
SECTION 1011
—
01
—
051505279
BLUE CROSS
AL
01
—
051505995
BLUE CROSS
AL
01
—
051513008
BLUE CROSS
AL
01
—
300032377
RAILROAD MEDICARE
AL
01
—
5239044
MISSISSIPPI MEDICAID
MS
01
—
C76277
VIVA
AL
Enumeration date
05/16/2006
Last updated
07/12/2011
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