Provider Demographics
NPI:1295810257
Name:RASIS, RON D (PA)
Entity type:Individual
Prefix:MR
First Name:RON
Middle Name:D
Last Name:RASIS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1241 W MINERAL AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-5685
Mailing Address - Country:US
Mailing Address - Phone:303-759-0854
Mailing Address - Fax:303-759-0864
Practice Address - Street 1:4231 W 16TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-1335
Practice Address - Country:US
Practice Address - Phone:303-629-3721
Practice Address - Fax:303-629-2192
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO2320363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO018893OtherKAISER COMMERCIAL NUMBER
CO78786347Medicaid
COCO811884Medicare PIN
CO78786347Medicaid