Paul Sanner MD PA
Organization Active NPI Family Medicine Physician · Malakoff, TX
NPI 1972898153 · NPPES record last updated Jun 15, 2011
Key facts
- NPI
- 1972898153
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- E6603 (TX)
- Legal business name
- PAUL SANNER MD PA
- Practice address
- 815 E Royall Blvd Ste 3
Malakoff, TX 75148-9255 - Phone
- (903) 489-0101
- Fax
- (903) 489-9136
- NPI assigned
- Jun 15, 2011
- Organization subpart
- No
Authorized official
- Name
- Dr. David Paul Sanner, MD
- Title
- Owner
- Phone
- (903) 489-0101
Practitioners 5
-
David Paul Sanner, M.D.
-
Erik Tijerina, FNP
-
Julie Nell Kilcrease, FNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D0983548 | Sanner, Paul MD | Certificate of waiver | Feb 25, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120105000963 | TX | Part B Supplier - Clinic/Group Practice | 0547436909 |
Receives reassigned benefits from 1 practitioner Practice locations: Malakoff, TX |
National Provider Directory
Locations
815 E Royall Blvd
Ste 3
Malakoff, TX 75148
Phone (903) 489-0101
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | E6603 | TX | Yes |
Addresses
Primary practice location
815 E Royall Blvd Ste 3
Malakoff, TX 75148-9255
Mailing address
815 E Royall Blvd Ste 3
Malakoff, TX 75148-9255
Phone (903) 489-0101
Other providers in Malakoff, TX
- Malakoff I.S.D.
- Malakoff Prescription Shop, Inc
- Martha Gail Miller
- Alvon Joseph McBride
- Georgette Carolyn Nichols
- Amanda Nicole Reyes
- Julianna Royston
- David Paul Sanner
- Kathryn Lynn Tucker
- Heather Elizabeth Weaks
All providers in Malakoff, TX · Family Medicine Physician in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 15, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.