Individual
DERAR ZAKARYYA SHANWAN ALBASHAIREH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.B.B.S
Contact information
Practice address
3670 PARKER BLVD STE 101, PUEBLO, CO 81008-2285
(719) 562-2900
(719) 924-1592
Mailing address
PO BOX 560825, DENVER, CO 80256-0825
(719) 595-7580
(719) 545-0176
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301098836
MI
207R00000X
Internal Medicine Physician
MD.207044
LA
207RI0011X
Interventional Cardiology Physician
Primary
DR.0060690
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9000163537
—
CO
Enumeration date
07/19/2011
Last updated
09/10/2018
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