Healthcare Provider Details

I. General information

NPI: 1417957168
Provider Name (Legal Business Name): WILLIAM SCOTT SAGEMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 09/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 DOLBEER ST
EUREKA CA
95501-4736
US

IV. Provider business mailing address

2700 DOLBEER ST
EUREKA CA
95501-4736
US

V. Phone/Fax

Practice location:
  • Phone: 707-269-4253
  • Fax: 707-269-3802
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberG58846
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberG58846
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: