Provider Demographics
NPI:1639369895
Name:RAVIN, THOMAS HYME (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:HYME
Last Name:RAVIN
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 1:45 S DAHLIA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1044
Mailing Address - Country:US
Mailing Address - Phone:303-331-9339
Mailing Address - Fax:303-331-9338
Practice Address - Street 1:45 S DAHLIA ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1044
Practice Address - Country:US
Practice Address - Phone:303-331-9339
Practice Address - Fax:303-331-9338
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16838208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO74691OtherMEDICARE OPT OUT NUMBER