Sanford, Clyde Fagg

Sanford, Clyde Fagg is an individual health care provider with primary practice located at 703 S Fleishel Ave Ste 4000, Tyler TX 75701-2015. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Cardiovascular Disease, Allopathic & Osteopathic Physicians / Interventional Cardiology, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Cardiovascular Disease is his primary health care specialty. Sanford, Clyde Fagg can be contacted via phone (903) 606-7000.

Contact Information

Primary practice address
703 S Fleishel Ave Ste 4000 Tyler TX 75701-2015
Phone: (903) 606-7000
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X E9970 Texas
Allopathic & Osteopathic Physicians / Interventional Cardiology 207RI0011X E9970 Texas
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X E9970 Texas

Profile Details

NPI number 1528053857
LBN Legal business name Sanford, Clyde Fagg
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 13th, 2005
Last updated Jul 8th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1528053857 NPPES
Texas MEDICAID 128834206
Texas Other 4538099
Texas Other 038665009
Texas MEDICAID 128834202
Texas Other 089421J
Texas Other 752616977007

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