Provider Demographics
NPI:1548316284
Name:SANDERS, DALLAS R (PA-C)
Entity type:Individual
Prefix:
First Name:DALLAS
Middle Name:R
Last Name:SANDERS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-5700
Mailing Address - Fax:515-643-5739
Practice Address - Street 1:1350 DES MOINES ST STE 100
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-5507
Practice Address - Country:US
Practice Address - Phone:515-643-5700
Practice Address - Fax:515-643-5739
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001546363AM0700X
IA01546363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAQ13306Medicare UPIN
IAI12203Medicare PIN