Provider Demographics
NPI:1184967234
Name:MERSON, RYAN CHRISTOPHER (PA-C)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:CHRISTOPHER
Last Name:MERSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 OGDEN STREET
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218
Mailing Address - Country:US
Mailing Address - Phone:303-318-2460
Mailing Address - Fax:303-318-2489
Practice Address - Street 1:1960 NORTH OGDEN STREET
Practice Address - Street 2:SUITE 110
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-3667
Practice Address - Country:US
Practice Address - Phone:303-318-2460
Practice Address - Fax:303-318-2489
Is Sole Proprietor?:No
Enumeration Date:2013-03-27
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0004874363AM0700X
COPA.0005881363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical