Jeremy Drew Sanderson, MD, PA

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

P2164 Issued in TX

Legal business name

JEREMY DREW SANDERSON, MD, PA

Practice address

4370 Medical Arts Dr
Suite 200
Flower Mound, TX 75028-1712

Phone

(972) 691-7900

Fax

(972) 691-7910

NPI assigned

Dec 28, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jeremy Drew Sanderson, M.D.NPI 1679792048

Title

Owner

Phone

(210) 837-4524

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jeremy Drew Sanderson, M.D.

  • Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
  • Flower Mound, TX
  • NPI 1679792048
  Medicare reassignment NPD Authorized official
• Anthony Braswell, M.D.

  • Surgery Physician
  • San Antonio, TX
  • NPI 1528035482
  Medicare reassignment NPD
• Stephanie Stovall, APRN, FNP-C

  • Family Nurse Practitioner
  • Southlake, TX
  • NPI 1770175564
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1356652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372204800000",
    "number": "1609112358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6101 LONG PRAIRIE RD",
            "address_2": "SUITE 744-281",
            "city": "FLOWER MOUND",
            "state": "TX",
            "postal_code": "750286221",
            "telephone_number": "972-691-7900",
            "fax_number": "972-691-7910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4370 MEDICAL ARTS DR",
            "address_2": "SUITE 200",
            "city": "FLOWER MOUND",
            "state": "TX",
            "postal_code": "750281712",
            "telephone_number": "972-691-7900",
            "fax_number": "972-691-7910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEREMY DREW SANDERSON, MD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-28",
        "last_updated": "2013-06-26",
        "status": "A",
        "authorized_official_last_name": "SANDERSON",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "DREW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "210-837-4524",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207YX0007X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology, Plastic Surgery within the Head & Neck",
            "state": "TX",
            "license": "P2164",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Plastic Surgery",
            "state": "TX",
            "license": "P2164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jocelyn B Dunham, MD,PA
• Katherine Elizabeth Johanan

• Plastic Surgery Physician in Flower Mound, TX
• Providers in Flower Mound, TX by specialty
• Plastic Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.