Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | M-10668 | ID |
N | 207Q00000X | Family Doctor | MD00046953 | WA |
N | 207QS0010X | Family Doctor - Sports Medicine | M-10668 | ID |
NPI | 1316143886 |
---|---|
Provider Name | Shelley R Ringo |
First Address | Boise, ID 83703-2739 |
Second Address | Boise, ID 83703-2739 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2007 |
Last Update Date | 03/08/2010 |