Healthcare Provider Details

I. General information

NPI: 1366728263
Provider Name (Legal Business Name): RYAN EVERETT LINDSAY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2011
Last Update Date: 12/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 N COLE RD
BOISE ID
83704-9117
US

IV. Provider business mailing address

650 N COLE RD
BOISE ID
83704-9117
US

V. Phone/Fax

Practice location:
  • Phone: 208-323-1222
  • Fax:
Mailing address:
  • Phone: 208-323-1222
  • Fax: 208-323-1825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberO-0707
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: