Provider Demographics
NPI:1912698119
Name:SAKOURY, TARIQ (PAS 1)
Entity Type:Individual
Prefix:
First Name:TARIQ
Middle Name:
Last Name:SAKOURY
Suffix:
Gender:M
Credentials:PAS 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8401 S CHAMBERS RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3276
Mailing Address - Country:US
Mailing Address - Phone:303-373-2008
Mailing Address - Fax:
Practice Address - Street 1:8401 S CHAMBERS RD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-3276
Practice Address - Country:US
Practice Address - Phone:303-373-2008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant