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Individual

MICHAEL J RYAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
232 S WHISPERWOOD WAY, BOISE, ID 83709-4900
(208) 350-6450
Mailing address
PO BOX 9649, BOISE, ID 83707-4649
(208) 472-8100
(208) 344-1926

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
M5502
ID
208D00000X
General Practice Physician
Primary
M5502
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
003908900
ID
Enumeration date
06/09/2006
Last updated
03/12/2014
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