Basic Information
| Provider Information | |||||||||
| NPI: | 1922480730 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOOD | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | KELLY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5200 DTC PKWY | ||||||||
| Address2: | STE 400 | ||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801112719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7204763364 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5200 DTC PKWY STE 400 | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801112719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037450000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2015 | ||||||||
| LastUpdateDate: | 03/03/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 2015016457 | MO | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207R00000X | 0006012 | CO | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 59610 | CO | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.