Individual
DAVID A RILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1300 ANNE ST NW, BEMIDJI, MN 56601-5103
(218) 333-5000
Mailing address
PO BOX 2010, FARGO, ND 58122-2484
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
59006
MN
207Y00000X
Otolaryngology Physician
MD00030575
WA
207YS0123X
Facial Plastic Surgery Physician
MD00030575
WA
207YX0602X
Otolaryngic Allergy Physician
MD00030575
WA
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
MD00030575
WA
208600000X
Surgery Physician
MD00030575
WA
2086S0122X
Plastic and Reconstructive Surgery Physician
MD00030575
WA
2086X0206X
Surgical Oncology Physician
MD00030575
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
122444
STATE LABOR & INDUSTRIES
WA
05
—
8227415
—
WA
01
—
MD00030575
WA STATE MEDICAL LICENSE
WA
Enumeration date
02/21/2006
Last updated
05/24/2019
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