Healthcare Provider Details

I. General information

NPI: 1922209527
Provider Name (Legal Business Name): RYAN CHRISTOPHER BRADLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RYAN CHRISTOPHER BRADLEY M.D.

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12230 LIONESS WAY
PARKER CO
80134-5603
US

IV. Provider business mailing address

9250 E COSTILLA AVE STE 540
GREENWOOD VILLAGE CO
80112-3648
US

V. Phone/Fax

Practice location:
  • Phone: 720-644-9355
  • Fax:
Mailing address:
  • Phone: 720-644-9355
  • Fax: 303-306-7753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301089986
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301089986
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDR.0054936
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: