Provider Demographics
NPI:1225182314
Name:SAGER, WAYNE LESLIE (MD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:LESLIE
Last Name:SAGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5419 N LOVINGTON HWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-9131
Mailing Address - Country:US
Mailing Address - Phone:505-392-1503
Mailing Address - Fax:505-392-5698
Practice Address - Street 1:5419 N LOVINGTON HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-9131
Practice Address - Country:US
Practice Address - Phone:505-392-1503
Practice Address - Fax:505-392-5698
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2003-0554208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTG29289Medicare UPIN