1033188917 NPI number — DR. ANGELO SAM GIARRATANO DPM

Table of content: DR. ANGELO SAM GIARRATANO DPM (NPI 1033188917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033188917 NPI number — DR. ANGELO SAM GIARRATANO DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIARRATANO
Provider First Name:
ANGELO
Provider Middle Name:
SAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033188917
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2037 JERRY MURPHY RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
PUEBLO
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81001-1256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-544-6505
Provider Business Mailing Address Fax Number:
719-546-8644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2037 JERRY MURPHY RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
PUEBLO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81001-1256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-544-6505
Provider Business Practice Location Address Fax Number:
719-546-8644
Provider Enumeration Date:
03/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  304 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 51963 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 480033178 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".