Basic Information
| Provider Information | |||||||||
| NPI: | 1770791055 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RILEY | ||||||||
| FirstName: | JAREN | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4900 S MONACO ST | ||||||||
| Address2: | #210 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802373486 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038612663 | ||||||||
| FaxNumber: | 3038614741 | ||||||||
| Practice Location | |||||||||
| Address1: | 2055 N HIGH ST | ||||||||
| Address2: | #130 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802055503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038612663 | ||||||||
| FaxNumber: | 3038614741 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2007 | ||||||||
| LastUpdateDate: | 01/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | R-7402 | IA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XP3100X | 48800 | CO | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Pediatric Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 10025633000 | 05 | NE | MEDICAID | 1770791055 | 05 | SD | MEDICAID | 200320870A | 05 | OK | MEDICAID | 58958274 | 05 | CO | MEDICAID | 1770791055 | 05 | WY | MEDICAID |