Healthcare Provider Details

I. General information

NPI: 1477506350
Provider Name (Legal Business Name): DANIEL D RIRIE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 E BANNOCK ST
BOISE ID
83712-6241
US

IV. Provider business mailing address

PO BOX 9696
BOISE ID
83707-4696
US

V. Phone/Fax

Practice location:
  • Phone: 208-381-2094
  • Fax:
Mailing address:
  • Phone: 208-472-8118
  • Fax: 208-344-1926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberM9356
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: