Individual
MR. RYAN KENNETH AVERETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
2221 N IRONWOOD CENTER DR, COEUR D ALENE, ID 83814-2697
(208) 667-3585
(855) 864-8364
Mailing address
2221 N IRONWOOD CENTER DR, COEUR D ALENE, ID 83814-2697
(208) 667-3585
(855) 864-8364
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
P177
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010147409
REGENCE BLUE SHIELD
ID
01
—
1351085
MEDICARE
ID
05
—
806936200
—
ID
01
—
P2451
BLUE CROSS OF IDAHO
—
Enumeration date
10/04/2005
Last updated
04/22/2016
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