Provider Demographics
NPI:1326722703
Name:SHEPHARD, RYAN JAMES (PA-C)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:JAMES
Last Name:SHEPHARD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13757 W AMHERST WAY
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-4967
Mailing Address - Country:US
Mailing Address - Phone:303-653-8596
Mailing Address - Fax:
Practice Address - Street 1:1360 S POTOMAC ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4505
Practice Address - Country:US
Practice Address - Phone:303-337-5575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0007847363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant