Basic Information
| Provider Information | |||||||||
| NPI: | 1609837210 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANDERLIN | ||||||||
| FirstName: | BRENT | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5013 KYLE CENTER DRIVE, | ||||||||
| Address2: | SUITE 104 SETON FAMILY OF DOCTORS AT HAYS | ||||||||
| City: | KYLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5125040855 | ||||||||
| FaxNumber: | 5125040856 | ||||||||
| Practice Location | |||||||||
| Address1: | 5013 KYLE CENTER DRIVE, | ||||||||
| Address2: | SUITE 104 SETON FAMILY OF DOCTORS AT HAYS | ||||||||
| City: | KYLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5125040855 | ||||||||
| FaxNumber: | 5125040856 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2006 | ||||||||
| LastUpdateDate: | 07/11/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | K2786 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.