Individual
RYAN G WILLMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
335 E MAIN ST STE 1, SAINT ANTHONY, ID 83445-1546
(208) 356-4900
(208) 624-4116
Mailing address
PO BOX 18, SAINT ANTHONY, ID 83445-0018
(208) 356-4900
(208) 624-4112
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1802
ID
Other
Enumeration date
03/15/2019
Last updated
10/08/2024
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