Provider Demographics
NPI:1720053812
Name:OBLACHINSKI, RYAN J (DO)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:J
Last Name:OBLACHINSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 W HAMPDEN AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-2330
Mailing Address - Country:US
Mailing Address - Phone:303-761-5646
Mailing Address - Fax:303-761-7989
Practice Address - Street 1:333 W HAMPDEN AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-2330
Practice Address - Country:US
Practice Address - Phone:303-761-5646
Practice Address - Fax:303-761-7989
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42526207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO94320241Medicaid
COH88968Medicare UPIN
CO529318Medicare ID - Type Unspecified