Basic Information
| Provider Information | |||||||||
| NPI: | 1740384130 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAGERMAN | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 35760 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857405760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207220777 | ||||||||
| FaxNumber: | 5202909713 | ||||||||
| Practice Location | |||||||||
| Address1: | 4582 N 1ST AVE | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857188602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208882121 | ||||||||
| FaxNumber: | 5208884850 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 04/23/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0101X | 34331 | AZ | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology |
ID Information
| ID | Type | State | Issuer | Description | 162146 | 05 | AZ | MEDICAID | 34331 | 01 | AZ | STATE LICENSE | OTHER |