Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | O-0405 | ID |
NPI | 1053481366 |
---|---|
Provider Name | Suzanne Michelle Ring |
First Address | Boise, ID 83702-4566 |
Second Address | Boise, ID 83702-4566 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 08/07/2007 |