Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 59006 | MN |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | MD00030575 | WA |
N | 207YS0123X | Facial Plastic Surgeon | MD00030575 | WA |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | MD00030575 | WA |
N | 208200000X | Surgeon | MD00030575 | WA |
N | 208600000X | Surgeon | MD00030575 | WA |
N | 2086S0122X | Plastic and Reconstructive Surgery | MD00030575 | WA |
N | 2086X0206X | Surgical Oncologist | MD00030575 | WA |
NPI | 1649245838 |
---|---|
Provider Name | David A Riley |
First Address | Fargo, ND 58122-2484 |
Second Address | Bemidji, MN 56601-5103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2006 |
Last Update Date | 24/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
122444 | STATE LABOR & INDUSTRIES (01) | WA |
8227415 | (05) | WA |
F56853 | (02) | WA |
MD00030575 | WA STATE MEDICAL LICENSE (01) | WA |