Provider Demographics
NPI:1609837210
Name:SANDERLIN, BRENT W (DO)
Entity type:Individual
Prefix:
First Name:BRENT
Middle Name:W
Last Name:SANDERLIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5013 KYLE CENTER DRIVE,
Mailing Address - Street 2:SUITE 104 SETON FAMILY OF DOCTORS AT HAYS
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640
Mailing Address - Country:US
Mailing Address - Phone:512-504-0855
Mailing Address - Fax:512-504-0856
Practice Address - Street 1:5013 KYLE CENTER DRIVE,
Practice Address - Street 2:SUITE 104 SETON FAMILY OF DOCTORS AT HAYS
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640
Practice Address - Country:US
Practice Address - Phone:512-504-0855
Practice Address - Fax:512-504-0856
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK2786207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L13291Medicare UPIN