Healthcare Provider Details

I. General information

NPI: 1366231904
Provider Name (Legal Business Name): SETH RYAN STEWART
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 N LOGAN ST STE 407
DENVER CO
80203-3155
US

IV. Provider business mailing address

899 N LOGAN ST STE 407
DENVER CO
80203-3155
US

V. Phone/Fax

Practice location:
  • Phone: 303-284-8674
  • Fax: 303-284-8674
Mailing address:
  • Phone: 303-284-8674
  • Fax: 303-284-8674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: