Individual
DR. PAUL R. SANDERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071002781
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001672882
BLUE CROSS PROVIDER NUMBE
IL
01
—
071002781
PROFESSIONAL LICENSE
IL
01
—
363522880
FEDERAL TAX I.D. NUMBER
IL
Enumeration date
08/01/2006
Last updated
09/09/2020
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