Provider Demographics
NPI:1164497079
Name:RICCIO, JOHN C (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:RICCIO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1241 WEST MINERAL AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-5685
Mailing Address - Country:US
Mailing Address - Phone:303-759-0854
Mailing Address - Fax:303-759-0864
Practice Address - Street 1:2525 SOUTH DOWNING STREET
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5817
Practice Address - Country:US
Practice Address - Phone:303-778-5666
Practice Address - Fax:303-778-5787
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2009-04-23
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Provider Licenses
StateLicense IDTaxonomies
CO26946207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01269463Medicaid
CO930020349OtherRR MEDICARE
CO01269463Medicaid
COCP2158Medicare PIN