Basic Information
| Provider Information | |||||||||
| NPI: | 1891774196 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RYAN | ||||||||
| FirstName: | JEFFREY | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5546 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802175546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014753900 | ||||||||
| FaxNumber: | 8014753901 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 W 2700 N | ||||||||
| Address2: | |||||||||
| City: | PLEASANT VIEW | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844044791 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014753600 | ||||||||
| FaxNumber: | 8014753601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2006 | ||||||||
| LastUpdateDate: | 02/03/2018 | ||||||||
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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 | 363A00000X | 4813150-1206 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.