Provider Demographics
NPI:1003847880
Name:SELBY, RILEY HALSTEAD III (DO)
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:HALSTEAD
Last Name:SELBY
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 PINON SHADOWS CIR
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-3440
Mailing Address - Country:US
Mailing Address - Phone:928-301-3971
Mailing Address - Fax:928-204-2577
Practice Address - Street 1:25 PINON SHADOWS CIR
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-3440
Practice Address - Country:US
Practice Address - Phone:928-301-3971
Practice Address - Fax:928-204-2577
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3737207P00000X
IL036-060893207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$-4Medicaid
IL$$$$$$$$$Medicaid
IL$$$$$$$$$-4Medicaid
E30023Medicare UPIN
ILK41206Medicare PIN