Healthcare Provider Details

I. General information

NPI: 1700159555
Provider Name (Legal Business Name): DAVID RYAN ORMOND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2012
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 6TH ST
LEWISTON ID
83501-2434
US

IV. Provider business mailing address

415 6TH ST
LEWISTON ID
83501-2434
US

V. Phone/Fax

Practice location:
  • Phone: 208-799-6655
  • Fax: 208-799-6649
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number267037
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number67516
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberDR.0053952
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: