Provider Demographics
NPI:1124603816
Name:CUTANEOUS ONCOLOGY SERVICES LLC
Entity Type:Organization
Organization Name:CUTANEOUS ONCOLOGY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DO, MS
Authorized Official - Phone:720-316-8091
Mailing Address - Street 1:499 E HAMPDEN AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2791
Mailing Address - Country:US
Mailing Address - Phone:720-316-8091
Mailing Address - Fax:833-979-0946
Practice Address - Street 1:1601 E 19TH AVE STE 3550
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1285
Practice Address - Country:US
Practice Address - Phone:720-316-8091
Practice Address - Fax:833-979-0946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-14
Last Update Date:2021-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1215524996Medicaid