Healthcare Provider Details

I. General information

NPI: 1346778420
Provider Name (Legal Business Name): RYAN COLLEEN LARKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 BUCHTEL BLVD
DENVER CO
80210-3447
US

IV. Provider business mailing address

JAMES W. WILSON JR. CENTER 3333 BEN WEINER DR SUITE 154
NEW ORLEANS LA
70118
US

V. Phone/Fax

Practice location:
  • Phone: 609-575-6045
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number0001597
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: