Healthcare Provider Details

I. General information

NPI: 1104735901
Provider Name (Legal Business Name): WILLIAM SAGE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 COMMERCE ST
FORT WORTH TX
76102-6509
US

IV. Provider business mailing address

1515 COMMERCE ST
FORT WORTH TX
76102-6509
US

V. Phone/Fax

Practice location:
  • Phone: 817-212-3935
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code209800000X
TaxonomyLegal Medicine (M.D./D.O.) Physician
License NumberN0426
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: