1437359239 NPI number — RYAN NAFFZIGER, M.D., P.C.

Table of content: (NPI 1437359239)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437359239 NPI number — RYAN NAFFZIGER, M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RYAN NAFFZIGER, M.D., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ANIMAS PLASTIC SURGERY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437359239
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
175 MERCADO ST
Provider Second Line Business Mailing Address:
STE 111
Provider Business Mailing Address City Name:
DURANGO
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81301-7318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-828-1199
Provider Business Mailing Address Fax Number:
970-828-1194

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
175 MERCADO ST
Provider Second Line Business Practice Location Address:
STE 111
Provider Business Practice Location Address City Name:
DURANGO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81301-7318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-828-1199
Provider Business Practice Location Address Fax Number:
970-828-1194
Provider Enumeration Date:
07/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NAFFZIGER
Authorized Official First Name:
RYAN
Authorized Official Middle Name:
T.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
970-828-1199

Provider Taxonomy Codes

  • Taxonomy code: 2082S0105X , with the licence number:  MD2004-0117 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2082S0105X , with the licence number: 47396 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 22552073 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 41752082 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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