Individual
DR. RYAN DANIEL HEYBORNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3025 W CHERRY LANE, MERIDIAN, ID 83642
(208) 302-6400
(208) 302-6455
Mailing address
3340 E GOLDSTONE WAY, MERIDIAN, ID 83642-1026
(208) 302-6400
(208) 302-6455
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
01062424A
IN
207P00000X
Emergency Medicine Physician
Primary
M10210
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
808011700
—
ID
Enumeration date
06/01/2007
Last updated
07/21/2022
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