Individual
DR. TERRANCE A RISKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8181 N CORNERSTONE DR, HAYDEN, ID 83835-8752
(208) 772-0785
(208) 762-2704
Mailing address
8181 N CORNERSTONE DR, HAYDEN, ID 83835-8752
(208) 772-0785
(208) 762-2704
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M6012
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002705900
—
ID
Enumeration date
11/22/2005
Last updated
05/10/2010
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