Doctor Name: | JOHN EDWARD RILEY |
NPI Number: | 1366503955 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | M-4996 |
Business Practice Address: | 300 Hospital Dr Orofino, ID - 835449034 |
Business Phone Number: | 2084764511 |
Business Fax Number: | 2084767898 |
Mailing Address: | 300 Hospital Dr, OROFINO |
State: | ID |
Postal Code: | 835449034 |
Phone Number: | 2084764511 |
Fax Number: | 2084767898 |
NPI Enumeration Date: | 12/13/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207QA0505X |
License Number: | M-4996 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Family Medicine |
Taxonomy Specialization: | Adult Medicine |
Taxonomy Definition: |