Provider Demographics
NPI:1891729117
Name:SAGE, CLARICE BERNADETTE (MD)
Entity Type:Individual
Prefix:
First Name:CLARICE
Middle Name:BERNADETTE
Last Name:SAGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80424-6347
Mailing Address - Country:US
Mailing Address - Phone:970-453-1010
Mailing Address - Fax:970-453-5407
Practice Address - Street 1:555 S PARK AVE
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:CO
Practice Address - Zip Code:80424-6347
Practice Address - Country:US
Practice Address - Phone:970-453-1010
Practice Address - Fax:970-453-5407
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0044434207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO81452039Medicaid
COBS9705952OtherDEA
CO84145895001OtherPACIFICARE
P00331235OtherRAILROAD MEDICARE
CO2370237OtherAETNA
COSO641446OtherBLUE CROSS OF COLO
CO44434OtherCOLORADO LICENSE
CO84145895001OtherPACIFICARE
CO81452039Medicaid