Individual
THOMAS RYAN GILES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2094
Mailing address
PO BOX 3300, LA PINE, OR 97739-3300
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2317
ID
363A00000X
Physician Assistant
PA184708
OR
Other
Enumeration date
09/27/2017
Last updated
09/13/2022
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