Provider Demographics
NPI:1649416843
Name:ROUGAS, SAM TOM (MD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:TOM
Last Name:ROUGAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4900 S MONACO ST
Mailing Address - Street 2:#210
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3486
Mailing Address - Country:US
Mailing Address - Phone:303-750-0822
Mailing Address - Fax:303-750-1298
Practice Address - Street 1:1601 E 19TH AVE
Practice Address - Street 2:#5000
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1216
Practice Address - Country:US
Practice Address - Phone:303-839-7100
Practice Address - Fax:303-839-7249
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2022-02-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
CO52644207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO36786845Medicaid
WY1649416843Medicaid
COP01262155Medicare PIN
CO36786845Medicaid