Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0003X | Hematology & Oncology | 3816 | CO |
NPI | 1053748020 |
---|---|
Provider Name | Ryan P Fallt |
First Address | Denver, CO 80237-3486 |
Second Address | Denver, CO 80205-5494 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2013 |
Last Update Date | 11/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
64082881 | (05) | CO |