MEDICARE: DR. SAMUEL A PIEDAD JR. M.D.

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	207RN0300X	Nephrology Physician	DR.0040409	CO
2	207R00000X	Internal Medicine Physician	40409	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295732493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL A PIEDAD JR. M.D.

Provider Business Mailing Address
First Line	:	2920 N CASCADE AVE
Second Line	:	STE 201
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-6264
Country	:	US
Telephone Number	:	719-227-0027
Fax Number	:	719-955-4958

Provider Business Practice Location Address
First Line	:	2920 N CASCADE AVE
Second Line	:	STE 201
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-6264
Country	:	US
Telephone Number	:	719-227-0027
Fax Number	:	719-955-4958

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

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	08/22/2019

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