Individual
RYAN BRADLEY LONGMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
777 HOSPITAL WAY # 101, POCATELLO, ID 83201-5175
(208) 234-2001
(208) 232-2195
Mailing address
777 HOSPITAL WAY # 101, POCATELLO, ID 83201-5175
(208) 234-2001
(208) 232-2195
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2008024770
MO
207RC0000X
Cardiovascular Disease Physician
Primary
O-0884
ID
Other
Enumeration date
09/26/2008
Last updated
02/05/2025
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