MEDICARE: RYAN MOIR TIXIER

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	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1518364710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN MOIR TIXIER

Provider Business Mailing Address
First Line	:	901 SHERMAN ST
Second Line	:	APT 322
City	:	DENVER
State	:	CO
Zip	:	80203-2916
Country	:	US
Telephone Number	:	626-623-9604
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 SHERMAN ST
Second Line	:	APT 322
City	:	DENVER
State	:	CO
Zip	:	80203-2916
Country	:	US
Telephone Number	:	626-623-9604
Fax Number	:

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

Provider Enumeration Date	:	12/03/2014
Last Update Date	:	12/03/2014

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Directions to “ RYAN MOIR TIXIER ” Practice Location

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