Individual
DR. RICHARD C BALLANTYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
215 E HAWAII AVE, NAMPA, ID 83686-6011
(208) 364-3000
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
IA-3634
IA
208600000X
Surgery Physician
IA-3634
IA
208600000X
Surgery Physician
Primary
O0485
ID
Other
Enumeration date
05/03/2007
Last updated
01/28/2014
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