Provider Demographics
NPI:1134106222
Name:JAPP, DAVID RYAN (PAC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:RYAN
Last Name:JAPP
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4323 INTEGRITY CENTER PT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-1683
Mailing Address - Country:US
Mailing Address - Phone:719-591-2558
Mailing Address - Fax:719-591-2596
Practice Address - Street 1:1035 GARDEN OF THE GODS RD STE 120
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-3416
Practice Address - Country:US
Practice Address - Phone:719-329-1000
Practice Address - Fax:719-598-0807
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1389363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO47280271Medicaid
P22921Medicare UPIN
CO47280271Medicaid