Provider Demographics
NPI:1558378042
Name:DUHON, SAMUEL C (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:C
Last Name:DUHON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 570
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81002-0570
Mailing Address - Country:US
Mailing Address - Phone:719-296-5840
Mailing Address - Fax:719-542-0746
Practice Address - Street 1:916 INDIANA AVE STE 120
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3572
Practice Address - Country:US
Practice Address - Phone:719-296-5841
Practice Address - Fax:719-542-0746
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO18781207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01187814Medicaid
050051088OtherRR MEDICARE
CH6461OtherRR MEDICARE - GROUP
PH18408OtherBCBS
050051088OtherRR MEDICARE
COC18428Medicare PIN