Individual
HEIKO WEERT DE RIESE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
403 S 11TH ST STE 210, BOISE, ID 83702-6968
(208) 381-6005
(208) 381-6006
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
10964340-1205
UT
2084P0800X
Psychiatry Physician
Primary
M-16773
ID
Other
Enumeration date
04/03/2017
Last updated
10/09/2024
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