Healthcare Provider Details

I. General information

NPI: 1700974219
Provider Name (Legal Business Name): JOAN DONNA MARIE SAGE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS JOAN DONNA MARIE BOWEN

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9800 SE SUNNYSIDE RD
CLACKAMAS OR
97015-9750
US

IV. Provider business mailing address

9800 SE SUNNYSIDE RD
CLACKAMAS OR
97015-9750
US

V. Phone/Fax

Practice location:
  • Phone: 503-652-2880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD14475
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00025388
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: