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General NPI Number Information
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NPI Number | 1245784248
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Entity Type | Organization
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Legal Business Name | INNOVATIVE CANCER CARE, PLLC
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Dates
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Enumeration Date | 08/08/2016
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Last Update Date | 08/08/2016
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Provider Practice Location Address
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Address Line | 5275 DTC PKWY
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-2772
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Country | US
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Telephone | 303-570-2760
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Fax | 303-770-0792
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Provider Business Mailing Address
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Address Line | 4704 HARLAN ST
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City | DENVER
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State | CO
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Zip | 80212-7415
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Country | US
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Telephone | 720-382-1008
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Fax | 720-382-1012
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BARRY D BLYTON
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Credential | MD
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Telephone | 303-570-2760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 39830
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License Number State | CO
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