Provider Demographics
NPI:1679792048
Name:SANDERSON, JEREMY DREW (MD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:DREW
Last Name:SANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 LONG PRAIRIE RD
Mailing Address - Street 2:SUITE 744-281
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-6221
Mailing Address - Country:US
Mailing Address - Phone:972-691-7900
Mailing Address - Fax:972-691-7910
Practice Address - Street 1:4370 MEDICAL ARTS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1712
Practice Address - Country:US
Practice Address - Phone:972-691-7900
Practice Address - Fax:972-691-7910
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN207Y00000X
TX262902082S0099X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology