Provider Demographics
NPI:1881693570
Name:DESERT SAGE MEDICAL
Entity type:Organization
Organization Name:DESERT SAGE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:BOWER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-884-2929
Mailing Address - Street 1:844 W NYE LN
Mailing Address - Street 2:#201
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-1544
Mailing Address - Country:US
Mailing Address - Phone:775-884-2929
Mailing Address - Fax:775-884-0426
Practice Address - Street 1:844 W NYE LN
Practice Address - Street 2:#201
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-1544
Practice Address - Country:US
Practice Address - Phone:775-884-2929
Practice Address - Fax:775-884-0426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6493207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002013038Medicaid
NVV31637Medicare ID - Type Unspecified
NVV31638Medicare ID - Type Unspecified
NV002013038Medicaid