Individual
DR. DERIC V RAVSTEN
Active
Individual
DR. DERIC V RAVSTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
DO219571
OR
2084P0800X
Psychiatry Physician
O-290
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010154744
REGENCE BLUE SHIELD OF ID
ID
05
—
806453300
—
ID
01
—
S6444
BLUE CROSS OF IDAHO
ID
Enumeration date
08/30/2006
Last updated
03/17/2025
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