Provider Demographics
NPI:1518639616
Name:COLORADO PLASTIC AND RECONSTRUCTIVE SURGERY PLLC
Entity Type:Organization
Organization Name:COLORADO PLASTIC AND RECONSTRUCTIVE SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ENDRESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-853-5791
Mailing Address - Street 1:10535 PARK MEADOWS BLVD STE 350
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-8401
Mailing Address - Country:US
Mailing Address - Phone:720-853-5791
Mailing Address - Fax:
Practice Address - Street 1:10535 PARK MEADOWS BLVD STE 350
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-8401
Practice Address - Country:US
Practice Address - Phone:720-853-5791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-28
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODR.0064390OtherMEDICAL LICENSE