Healthcare Provider Details

I. General information

NPI: 1427589480
Provider Name (Legal Business Name): RYAN MATTHEW TOWN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 N HIGH ST STE 270
DENVER CO
80205-5503
US

IV. Provider business mailing address

2055 N HIGH ST STE 270
DENVER CO
80205-5503
US

V. Phone/Fax

Practice location:
  • Phone: 303-301-9010
  • Fax: 303-830-3165
Mailing address:
  • Phone: 303-301-9010
  • Fax: 303-830-3165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberDR.0071300
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: