Provider Demographics
NPI:1245598408
Name:SAVAGE, AUTUMN (DO)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:DO
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 3409
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78691-3409
Mailing Address - Country:US
Mailing Address - Phone:513-252-7792
Mailing Address - Fax:513-904-5908
Practice Address - Street 1:1300 W ROSEDALE ST STE A
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2824
Practice Address - Country:US
Practice Address - Phone:817-730-5300
Practice Address - Fax:817-989-6819
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ2848207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX366545702Medicaid
TX366545703Medicaid
TX366545701Medicaid