Averett, Ryan Kenneth

Averett, Ryan Kenneth is an sole proprietor health care provider with primary practice located at 2221 N Ironwood Center Dr , Coeur D Alene ID 83814-2697. He recently has only one registered license in Podiatric Medicine & Surgery Service Providers / Podiatrist, which is considered as his primary health care specialty. Averett, Ryan Kenneth can be contacted via phone (208) 667-3585.

Contact Information

Primary practice address
2221 N Ironwood Center Dr Coeur D Alene ID 83814-2697
Phone: (208) 667-3585
Fax: (855) 864-8364
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Podiatric Medicine & Surgery Service Providers / Podiatrist 213E00000X P177 Idaho

Profile Details

NPI number 1629065610
LBN Legal business name Averett, Ryan Kenneth
Credentials Doctor of Podiatric Medicine (DPM)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 4th, 2005
Last updated Apr 22nd, 2016 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1629065610 NPPES
Idaho MEDICAID 806936200
Idaho Other P2451
Idaho Other 000010147409
Idaho Other 1351085

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