Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 036-060893 | IL |
Y | 207P00000X | Emergency Physician | 3737 | AZ |
NPI | 1003847880 |
---|---|
Provider Name | Riley Halstead Selby III |
First Address | Sedona, AZ 86336-3440 |
Second Address | Sedona, AZ 86336-3440 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 07/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E30023 | (02) |