Provider Demographics
NPI:1417119553
Name:CRETE, RYAN NICHOLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:NICHOLAS
Last Name:CRETE
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 1:10800 E GEDDES AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3895
Mailing Address - Country:US
Mailing Address - Phone:303-761-9190
Mailing Address - Fax:720-874-4462
Practice Address - Street 1:500 ALA MOANA BLVD STE 5B
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:303-761-9190
Practice Address - Fax:720-874-4462
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO597572085R0202X
KS04-406982085R0202X
NE306032085R0202X
HIMD-152892085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026277400Medicaid
CO627576YQPGOtherMEDICARE
CO627576ZLJ3OtherMEDICARE
NE84089712600Medicaid
KS111257114OtherMEDICARE
CO627576YQ33OtherMEDICARE
NE10026277300Medicaid
CO627576AE6YOtherMEDICARE
CO627576YQN9OtherMEDICARE
CO627576ZNTBOtherMEDICARE
HIH111054OtherMEDICARE
NE10026277700Medicaid
NE84059792913Medicaid
KSKA3249105OtherMEDICARE
CO9000156797Medicaid
NE10025709000Medicaid
HIH104776OtherMEDICARE
NENA2517105OtherMEDICARE
NE10026277500Medicaid
NE10026277800Medicaid
NENA1214127OtherMEDICARE
NE10026277600Medicaid
HIH104995OtherMEDICARE
NENA1215128OtherMEDICARE