Individual
DR. RYAN LEWIS VAN DE GRAAFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
900 N LIBERTY ST., STE 400, BOISE, ID 83704
(208) 367-3320
(208) 367-7474
Mailing address
900 N. LIBERTY ST., STE 400, BOISE, ID 83704
(208) 367-3320
(208) 367-7474
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
22476
NE
207Y00000X
Otolaryngology Physician
Primary
M-10288
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
808096700
—
ID
Enumeration date
10/13/2006
Last updated
06/01/2010
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