Provider Demographics
NPI:1255002101
Name:SAGE DERMATOLOGY LLC
Entity Type:Organization
Organization Name:SAGE DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ECKER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:970-682-3377
Mailing Address - Street 1:2710 WESTRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-6503
Mailing Address - Country:US
Mailing Address - Phone:970-682-3377
Mailing Address - Fax:970-682-3340
Practice Address - Street 1:1548 BOISE AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-4215
Practice Address - Country:US
Practice Address - Phone:970-682-3377
Practice Address - Fax:970-682-3340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-21
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty