Provider Demographics
NPI:1114926730
Name:SAGE, JEFFREY MERRICK (DO)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MERRICK
Last Name:SAGE
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1127 WILSHIRE BOULEVARD
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017
Mailing Address - Country:US
Mailing Address - Phone:213-250-5333
Mailing Address - Fax:
Practice Address - Street 1:1127 WILSHIRE BLVD
Practice Address - Street 2:SUITE 1600
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-3901
Practice Address - Country:US
Practice Address - Phone:213-250-5333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2024-12-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A5971207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE63880Medicare UPIN