Individual
RYAN JOE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RT (R)
Contact information
Practice address
2500 W A ST STE 201, MOSCOW, ID 83843-6000
(208) 596-8408
Mailing address
2323 CHARNITA DR, CLARKSTON, WA 99403-1429
(208) 596-8408
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
Primary
386921
ID
Other
Enumeration date
04/24/2025
Last updated
04/24/2025
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