Provider Demographics
NPI:1871553081
Name:IMES, SANDRA K (MD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:K
Last Name:IMES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7232 NORTH FREEWAY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137
Mailing Address - Country:US
Mailing Address - Phone:817-439-8100
Mailing Address - Fax:817-439-8103
Practice Address - Street 1:7232 NORTH FREEWAY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137
Practice Address - Country:US
Practice Address - Phone:817-439-8100
Practice Address - Fax:817-439-8103
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0071207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85682NOtherBLUE SHIELD
TX0439895-01Medicaid
TX080161871OtherRR/MEDICARE
TX85682NOtherBLUE SHIELD