Healthcare Provider Details

I. General information

NPI: 1043445513
Provider Name (Legal Business Name): RYAN D. HOPE, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2009
Last Update Date: 05/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 VISTA DR
POCATELLO ID
83201-4987
US

IV. Provider business mailing address

285 VISTA DR
POCATELLO ID
83201-4987
US

V. Phone/Fax

Practice location:
  • Phone: 208-233-8344
  • Fax: 208-233-6983
Mailing address:
  • Phone: 208-233-8344
  • Fax: 208-233-6983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberM-10047
License Number StateID

VIII. Authorized Official

Name: DR. RYAN D HOPE
Title or Position: OWNER
Credential: M.D.
Phone: 208-233-8344