Healthcare Provider Details

I. General information

NPI: 1598609687
Provider Name (Legal Business Name): MUHANNED SOUD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2635 N 7TH ST
GRAND JUNCTION CO
81501-8209
US

IV. Provider business mailing address

12309 E LASALLE PL
AURORA CO
80014-1921
US

V. Phone/Fax

Practice location:
  • Phone: 970-298-2195
  • Fax:
Mailing address:
  • Phone: 970-298-2195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: