Provider Demographics
NPI:1447634506
Name:SANDERS, ETHAN
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:
Last Name:SANDERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17490 STATE HWY3
Mailing Address - Street 2:SUITE B-300
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 GESSNER RD
Practice Address - Street 2:SUTIE 1225
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-4276
Practice Address - Country:US
Practice Address - Phone:713-468-3842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4730476672471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance Imaging