MEDICARE: RYAN P FALLT PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	3816	CO
2	363A00000X	Physician Assistant	3816	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053748020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN P FALLT PA-C

Provider Business Mailing Address
First Line	:	4900 S MONACO ST
Second Line	:	#210
City	:	DENVER
State	:	CO
Zip	:	80237-3486
Country	:	US
Telephone Number	:	720-754-4800
Fax Number	:	720-754-4801

Provider Business Practice Location Address
First Line	:	2045 FRANKLIN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80205-5494
Country	:	US
Telephone Number	:	303-861-3302
Fax Number	:	303-861-3498

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2013
Last Update Date	:	02/11/2022

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