Basic Information
| Provider Information | |||||||||
| NPI: | 1518994441 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SAUNDERS | ||||||||
| FirstName: | R. | ||||||||
| MiddleName: | CRAIG | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SAUNDERS | ||||||||
| OtherFirstName: | RALPH | ||||||||
| OtherMiddleName: | CRAIG | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 421 SEWELL DR | ||||||||
| Address2: | |||||||||
| City: | SPARTA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385831223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9317384395 | ||||||||
| FaxNumber: | 9317384330 | ||||||||
| Practice Location | |||||||||
| Address1: | 423 SEWELL DR | ||||||||
| Address2: | |||||||||
| City: | SPARTA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 385831223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9317389333 | ||||||||
| FaxNumber: | 9317389340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 12/22/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | J2779 | TX | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | MD49189 | TN | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 376710000 | 01 | TX | DEPARTMENT OF LABOR | OTHER | 88581X | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER |