MEDICARE: DR. VANSTON O MASRI D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	39.009748	OH
2	207L00000X	Anesthesiology Physician	0054513	CO
3	390200000X	Student in an Organized Health Care Education/Training Program	TL2872	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	026606	OTHER	CO	KAISER COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205087038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VANSTON O MASRI D.O.

Provider Business Mailing Address
First Line	:	1601 E 19TH AVE STE 3600
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-1252
Country	:	US
Telephone Number	:
Fax Number	:	844-443-3968

Provider Business Practice Location Address
First Line	:	1601 E 19TH AVE STE 3600
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-1252
Country	:	US
Telephone Number	:	720-515-2353
Fax Number	:	844-443-3968

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2008
Last Update Date	:	05/05/2021

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Directions to “ DR. VANSTON O MASRI D.O.” Practice Location

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