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General NPI Number Information
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NPI Number | 1972541993
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Entity Type | Individual
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Provider Name | TERRY SHIRA SAMUEL M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 06/22/2021
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Provider Practice Location Address
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Address Line | 11600 W 2ND PL
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City | LAKEWOOD
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State | CO
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Zip | 80228-1527
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Country | US
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Telephone | 719-537-0712
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Fax |
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Provider Business Mailing Address
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Address Line | 10350 E DAKOTA AVE
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City | DENVER
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State | CO
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Zip | 80247-1314
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 36121
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License Number State | CO
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