Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 10066 | CO |
Y | 213EG0000X | General Practice | 10066 | CO |
NPI | 1003147521 |
---|---|
Provider Name | Dr. Ryan T. Mangrum |
First Address | Westminster, CO 80003-6213 |
Second Address | Westminster, CO 80003-6213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2010 |
Last Update Date | 22/01/2010 |