Healthcare Provider Details

I. General information

NPI: 1053748020
Provider Name (Legal Business Name): RYAN P FALLT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2013
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 FRANKLIN ST
DENVER CO
80205-5494
US

IV. Provider business mailing address

4900 S MONACO ST #210
DENVER CO
80237-3486
US

V. Phone/Fax

Practice location:
  • Phone: 303-861-3302
  • Fax: 303-861-3498
Mailing address:
  • Phone: 720-754-4800
  • Fax: 720-754-4801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number3816
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3816
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: