MEDICARE: RICHARD M SAG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	ME46257	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	02435	OTHER	FL	BLUE SHIELD

General Provider Information

NPI Number	:	1649216730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD M SAG MD

Provider Business Mailing Address
First Line	:	PO BOX 741240
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32774-1240
Country	:	US
Telephone Number	:	386-774-5211
Fax Number	:	386-774-5251

Provider Business Practice Location Address
First Line	:	5401 ALHAMBRA DR
Second Line	:	SUITE D
City	:	ORLANDO
State	:	FL
Zip	:	32808-7081
Country	:	US
Telephone Number	:	407-297-1497
Fax Number	:	407-297-8917

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	06/02/2008

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