Provider Demographics
NPI:1306022884
Name:RICHARD M SAG MD PA
Entity Type:Organization
Organization Name:RICHARD M SAG MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT/REPRESENTATIVE
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:COOLIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:376-774-5211
Mailing Address - Street 1:PO BOX 741240
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32774-1240
Mailing Address - Country:US
Mailing Address - Phone:376-774-5211
Mailing Address - Fax:386-774-5251
Practice Address - Street 1:5401 ALHAMBRA DR
Practice Address - Street 2:SUITE D
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-7081
Practice Address - Country:US
Practice Address - Phone:407-297-1497
Practice Address - Fax:407-297-8917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME46257208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty