Provider Demographics
NPI:1851489801
Name:SAKAMOTO, GLENN D (MD)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:D
Last Name:SAKAMOTO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3333 S BANNOCK ST
Mailing Address - Street 2:SUITE 350
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-2432
Mailing Address - Country:US
Mailing Address - Phone:303-957-1310
Mailing Address - Fax:303-761-4252
Practice Address - Street 1:401 W HAMPDEN PL
Practice Address - Street 2:SUITE 210
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-2470
Practice Address - Country:US
Practice Address - Phone:303-722-6960
Practice Address - Fax:303-722-0462
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2017-03-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO30131208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01301316Medicaid
CO01301316Medicaid
CO349428Medicare PIN