Provider Demographics
NPI:1568409654
Name:ARTIST, RICKY L (MD)
Entity Type:Individual
Prefix:
First Name:RICKY
Middle Name:L
Last Name:ARTIST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:500 ELDORADO BLVD STE 6250
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-3421
Mailing Address - Country:US
Mailing Address - Phone:303-272-0768
Mailing Address - Fax:303-318-2488
Practice Address - Street 1:2803 ROSLYN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-2624
Practice Address - Country:US
Practice Address - Phone:303-403-6300
Practice Address - Fax:303-403-6315
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2013-12-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO25174207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01251743Medicaid
CO01251743Medicaid
COCO300960Medicare PIN