Healthcare Provider Details

I. General information

NPI: 1003053554
Provider Name (Legal Business Name): DANIEL RYAN HUMER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2009
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10535 PARK MEADOWS BLVD STE 102
LONE TREE CO
80124-8456
US

IV. Provider business mailing address

10200 GRAND CENTRAL AVE STE 220
OWINGS MILLS MD
21117-4366
US

V. Phone/Fax

Practice location:
  • Phone: 303-695-6106
  • Fax:
Mailing address:
  • Phone: 410-581-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2718
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: