Healthcare Provider Details

I. General information

NPI: 1598423444
Provider Name (Legal Business Name): RYAN FAY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 E 9TH AVE STE 510
DENVER CO
80220-3910
US

IV. Provider business mailing address

4545 E 9TH AVE STE 510
DENVER CO
80220-3910
US

V. Phone/Fax

Practice location:
  • Phone: 303-321-0700
  • Fax:
Mailing address:
  • Phone: 303-321-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-0007187
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: