| Ryan Joe Wallace, RT (R) | |
|
2500 W A St Ste 201, Moscow, ID 83843-6000 | |
| (208) 596-8408 | |
| Not Available |
| Full Name | Ryan Joe Wallace |
|---|---|
| Gender | Male |
| Speciality | Radiology - Body Imaging |
| Location | 2500 W A St Ste 201, Moscow, Idaho |
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770370488 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2085B0100X | Radiology - Body Imaging | 386921 (Idaho) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Ryan Joe Wallace, RT (R) 2323 Charnita Dr, Clarkston, WA 99403-1429 Ph: (208) 596-8408 | Ryan Joe Wallace, RT (R) 2500 W A St Ste 201, Moscow, ID 83843-6000 Ph: (208) 596-8408 |
Tucker Jeppson, DO Radiology Medicare: Not Enrolled in Medicare Practice Location: 220 W 3rd St, Moscow, ID 83843 Phone: 208-882-8369 | |
Robert M Farner, MD Radiology Medicare: Accepting Medicare Assignments Practice Location: 405 Styner Ave, Moscow, ID 83843 Phone: 208-882-8369 | |
Dean Easton, M.D. Radiology Medicare: Accepting Medicare Assignments Practice Location: 405 Styner Ave, Moscow, ID 83843 Phone: 208-882-8369 Fax: 208-882-1887 |