Provider Demographics
NPI:1073877213
Name:MILLER, RYAN NED (DO)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:NED
Last Name:MILLER
Suffix:
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 1:444 HOSPITAL WAY STE 710
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-2717
Mailing Address - Country:US
Mailing Address - Phone:435-760-0004
Mailing Address - Fax:208-233-4268
Practice Address - Street 1:444 HOSPITAL WAY STE 710
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201
Practice Address - Country:US
Practice Address - Phone:208-235-4263
Practice Address - Fax:208-233-4268
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-1148207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery