MEDICARE: DR. RICHARD HARRY MCILROY JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	9155	ND

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699862060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD HARRY MCILROY JR. MD

Provider Business Mailing Address
First Line	:	551 NORTH 800 WEST
Second Line	:
City	:	TETONIA
State	:	ID
Zip	:	83452
Country	:	US
Telephone Number	:	208-456-0984
Fax Number	:

Provider Business Practice Location Address
First Line	:	4021 S 700 E
Second Line	:	SUITE 300
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-2192
Country	:	US
Telephone Number	:	800-328-3048
Fax Number	:	801-264-6463

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	07/08/2007

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