Healthcare Provider Details

I. General information

NPI: 1942736251
Provider Name (Legal Business Name): RYAN SLABAUGH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2017
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 W 38TH AVE APT 644
DENVER CO
80211-2260
US

IV. Provider business mailing address

3400 W 38TH AVE APT 644
DENVER CO
80211-2260
US

V. Phone/Fax

Practice location:
  • Phone: 574-354-0638
  • Fax:
Mailing address:
  • Phone: 574-354-0638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number28473
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number111687
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number2026-034559
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number10959196-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: