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General NPI Number Information
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NPI Number | 1205164050
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Entity Type | Individual
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Provider Name | SAGE WEXNER MD
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Gender | Male
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Dates
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Enumeration Date | 12/04/2009
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 4815 ALAMEDA AVE
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City | EL PASO
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State | TX
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Zip | 79905-2705
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Country | US
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Telephone | 915-215-4600
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Fax | 915-545-7338
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Provider Business Mailing Address
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Address Line | 5130 GATEWAY BLVD E
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City | EL PASO
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State | TX
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Zip | 79905-1608
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Country | US
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Telephone | 915-215-4480
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Fax | 915-215-5386
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | A123563
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A123563
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 46698
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | V7105
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License Number State | TX
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