Provider Demographics
NPI:1366426926
Name:SAYRE, ROBERT L (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:SAYRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 RUSH DR
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-9627
Mailing Address - Country:US
Mailing Address - Phone:719-530-2200
Mailing Address - Fax:719-530-2201
Practice Address - Street 1:2312 N NEVADA AVE STE 400
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-5320
Practice Address - Country:US
Practice Address - Phone:719-577-2555
Practice Address - Fax:719-577-2553
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO25816207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COO1261874Medicaid
COC204038Medicare PIN
COO1261874Medicaid