Healthcare Provider Details

I. General information

NPI: 1770999112
Provider Name (Legal Business Name): SAAD ALSUBAIE M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 S BANNOCK ST STE 150
ENGLEWOOD CO
80110-2514
US

IV. Provider business mailing address

3333 S BANNOCK ST STE 150
ENGLEWOOD CO
80110-2514
US

V. Phone/Fax

Practice location:
  • Phone: 720-677-5649
  • Fax:
Mailing address:
  • Phone: 720-677-5649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberDR.0071867
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberDR.0071867
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberDR.0071867
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: