Provider Demographics
NPI:1780856120
Name:MAYBROOK, RYAN JONATHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JONATHAN
Last Name:MAYBROOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4900 S MONACO ST STE 210
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3487
Mailing Address - Country:US
Mailing Address - Phone:303-341-5751
Mailing Address - Fax:303-341-2618
Practice Address - Street 1:14100 E ARAPAHOE RD STE 130
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-4478
Practice Address - Country:US
Practice Address - Phone:303-341-5751
Practice Address - Fax:303-341-2618
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO55224207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO92000355Medicaid
NENA2301015OtherMEDICARE
CO416365YPNQOtherMEDICARE