Healthcare Provider Details

I. General information

NPI: 1205089661
Provider Name (Legal Business Name): RYAN THOMAS DONNELLY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3520 E 15TH ST STE 201
LOVELAND CO
80538-8939
US

IV. Provider business mailing address

3520 E 15TH ST STE 201
LOVELAND CO
80538-8939
US

V. Phone/Fax

Practice location:
  • Phone: 970-203-7165
  • Fax:
Mailing address:
  • Phone: 970-203-7165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR.0077202
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number7148380-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: