Individual
RYAN JOHN GILLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1919 LINCOLN WAY, 315, COEUR D ALENE, ID 83814-2527
(208) 625-6000
(208) 625-6001
Mailing address
2003 KOOTENAI HEALTH WAY, COEUR D ALENE, ID 83814-6051
(208) 625-4000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M10517
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1196263
MEDICARE PTAN
ID
05
—
807773300
—
ID
Enumeration date
07/05/2007
Last updated
04/14/2025
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