Provider Demographics
NPI:1295732493
Name:PIEDAD, SAMUEL A JR (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:A
Last Name:PIEDAD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2920 N CASCADE AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6264
Mailing Address - Country:US
Mailing Address - Phone:719-227-0027
Mailing Address - Fax:719-955-4958
Practice Address - Street 1:2920 N CASCADE AVE
Practice Address - Street 2:STE 201
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6264
Practice Address - Country:US
Practice Address - Phone:719-227-0027
Practice Address - Fax:719-955-4958
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0040409207RN0300X
CO40409207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO46281312Medicaid
CO46281312Medicaid
CO46281312Medicaid
COC467468Medicare PIN