Healthcare Provider Details

I. General information

NPI: 1619969672
Provider Name (Legal Business Name): GARY G SAUER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 HECKEL RD SUITE 107
MC KEES ROCKS PA
15136-1616
US

IV. Provider business mailing address

27 HECKEL RD SUITE 107
MC KEES ROCKS PA
15136-1616
US

V. Phone/Fax

Practice location:
  • Phone: 412-331-6503
  • Fax: 412-331-6804
Mailing address:
  • Phone: 412-331-6503
  • Fax: 412-331-6804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD041563E
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier001206331
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: