Provider Demographics
NPI:1184696411
Name:FERSZT, SAM (MD)
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:
Last Name:FERSZT
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 1:535 16TH ST
Mailing Address - Street 2:STE 750
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-4228
Mailing Address - Country:US
Mailing Address - Phone:303-825-4646
Mailing Address - Fax:303-825-3215
Practice Address - Street 1:535 16TH ST
Practice Address - Street 2:STE 750
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-4228
Practice Address - Country:US
Practice Address - Phone:303-825-4646
Practice Address - Fax:303-825-3215
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36953207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO22928243Medicaid
COCO307585Medicare PIN
COH03966Medicare UPIN
COC805268Medicare Oscar/Certification