Provider Demographics
NPI:1114193513
Name:KLEMT, RYAN MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:MATTHEW
Last Name:KLEMT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 S WADSWORTH BLVD UNIT 410
Mailing Address - Street 2:BRIGHTON COMMUNITY EMERGENCY PHYSICIANS; C/O EMMS
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-3118
Mailing Address - Country:US
Mailing Address - Phone:303-202-1281
Mailing Address - Fax:
Practice Address - Street 1:550 S WADSWORTH BLVD UNIT 410
Practice Address - Street 2:BRIGHTON COMMUNITY EMERGENCY PHYSICIANS; C/O EMMS
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-3118
Practice Address - Country:US
Practice Address - Phone:303-202-1281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO47487207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO58220089Medicaid
COCO305302Medicare PIN
COCO306428Medicare PIN