=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134491533
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEVEN B SAGER DO FACOG PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2012
-----------------------------------------------------
Last Update Date | 12/05/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9671 GLADIOLUS DR STE 111
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33908-7684
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-768-7071
-----------------------------------------------------
Fax | 239-768-7077
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9671 GLADIOLUS DR STE 111
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33908-7684
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-768-7071
-----------------------------------------------------
Fax | 239-768-7077
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING
-----------------------------------------------------
Name | JEANETTE ADAMS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 239-768-7071
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | OS6964
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------