Provider Demographics
NPI:1659361681
Name:OWSLEY, RYAN SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:SCOTT
Last Name:OWSLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16111 N BRINSON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-5509
Mailing Address - Country:US
Mailing Address - Phone:208-467-7546
Mailing Address - Fax:208-467-7500
Practice Address - Street 1:16111 N BRINSON ST STE 100
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-5509
Practice Address - Country:US
Practice Address - Phone:208-467-7546
Practice Address - Fax:208-467-7500
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM8483207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID070017125OtherRAILROAD MEDICARE
ID806364100Medicaid
IDB0909OtherBLUE CROSS
ID48561OtherBLUE CROSS
ID000010144611OtherBLUE SHIELD
ID000010147426OtherBLUE SHIELD
IDB0925OtherBLUE CROSS
ID000010138580OtherBLUE SHIELD
ID48553OtherBLUE CROSS
ID000010144611OtherBLUE SHIELD
ID000010147426OtherBLUE SHIELD