Healthcare Provider Details

I. General information

NPI: 1881323178
Provider Name (Legal Business Name): PETER MICHAEL RIZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

856 BANKS LOWMAN RD
GARDEN VALLEY ID
83622-8102
US

IV. Provider business mailing address

PO BOX 1330
CASCADE ID
83611-1330
US

V. Phone/Fax

Practice location:
  • Phone: 208-462-3533
  • Fax:
Mailing address:
  • Phone: 208-382-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-2711
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: