Healthcare Provider Details

I. General information

NPI: 1881897932
Provider Name (Legal Business Name): RYAN DON HOPE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 YELLOWSTONE AVE
POCATELLO ID
83201-4415
US

IV. Provider business mailing address

850 YELLOWSTONE AVE
POCATELLO ID
83201-4415
US

V. Phone/Fax

Practice location:
  • Phone: 208-239-8066
  • Fax: 208-239-8067
Mailing address:
  • Phone: 208-239-8066
  • Fax: 208-239-8067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberM-10047
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License NumberM-10047
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: