Provider Demographics
NPI:1003220815
Name:BIRD, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:BIRD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 W SOUTH BOULDER RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2854
Mailing Address - Country:US
Mailing Address - Phone:303-604-1444
Mailing Address - Fax:303-666-0911
Practice Address - Street 1:1140 W SOUTH BOULDER RD
Practice Address - Street 2:SUITE 202
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-2854
Practice Address - Country:US
Practice Address - Phone:303-604-1444
Practice Address - Fax:303-666-0911
Is Sole Proprietor?:No
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical