Basic Information
| Provider Information | |||||||||
| NPI: | 1427019215 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RYAN | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 S COLORADO BLVD | ||||||||
| Address2: | ANNEX BLDG, # 420 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802227900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7205241550 | ||||||||
| FaxNumber: | 7205241551 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 W DRY CREEK CIR | ||||||||
| Address2: | |||||||||
| City: | LITTLETON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801204427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039521100 | ||||||||
| FaxNumber: | 7202873183 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2006 | ||||||||
| LastUpdateDate: | 03/31/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 42273 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 65287746 | 05 | CO | MEDICAID | 22920358 | 05 | CO | MEDICAID |