Provider Demographics
NPI:1437359239
Name:RYAN NAFFZIGER, M.D., P.C.
Entity Type:Organization
Organization Name:RYAN NAFFZIGER, M.D., P.C.
Other - Org Name:ANIMAS PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:NAFFZIGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-828-1199
Mailing Address - Street 1:175 MERCADO ST
Mailing Address - Street 2:STE 111
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7318
Mailing Address - Country:US
Mailing Address - Phone:970-828-1199
Mailing Address - Fax:970-828-1194
Practice Address - Street 1:175 MERCADO ST
Practice Address - Street 2:STE 111
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7318
Practice Address - Country:US
Practice Address - Phone:970-828-1199
Practice Address - Fax:970-828-1194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2004-01172082S0105X
CO473962082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM22552073Medicaid
CO41752082Medicaid
CO41752082Medicaid
NM341432103Medicare PIN
102921Medicare UPIN