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General NPI Number Information
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NPI Number | 1255565933
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Entity Type | Individual
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Provider Name | RYAN JAMES MACDONALD M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/08/2009
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 7173 E SUPER 1 LOOP STE A
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City | ATHOL
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State | ID
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Zip | 83801
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Country | US
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Telephone | 208-561-9970
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Fax | 208-561-9997
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Provider Business Mailing Address
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Address Line | 1593 E POLSTON AVE
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City | POST FALLS
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State | ID
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Zip | 83854-5326
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Country | US
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Telephone | 208-262-2498
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Fax | 208-262-7461
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | M-16953
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License Number State | ID
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