MR. JODY LEE SANDERSON PA-C NPI 1164490579

NPI Information

NPI: 1164490579
Provider Name: MR. JODY LEE SANDERSON, PA-C
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

Organization: DAVIS ORTHOPAEDICS

PECOS Registration: Yes

Address:
1111 E MCDOWELL RD
PHOENIX, AZ
ZIP 85006
Phone: (602) 839-6968
Get Directions

MR. Jody Lee Sanderson, PA-C is a medical physician assistant in Phoenix, AZ with 24 years of experience. MR. Jody Lee Sanderson, PA-C NPI is 1164490579. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE
Graduation Year:2000

The provider's business location address is:

1111 E MCDOWELL RD
PHOENIX, AZ
ZIP 85006-612
Phone: (602) 839-6968
Fax: (602) 839-4144

The NPI 1164490579 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 3/10/2006 and was last updated on 7/29/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AM0700X	Physician Assistant	Medical	2580	ARIZONA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	649692	MEDICAID	ARIZONA
2	P60441	MEDICARE UPIN	ARIZONA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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