Provider Demographics
NPI:1831131085
Name:YAVRUIAN, RICK A (DO)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:A
Last Name:YAVRUIAN
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 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-367-2175
Mailing Address - Fax:208-376-0285
Practice Address - Street 1:131 N ALUMBAUGH ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9204
Practice Address - Country:US
Practice Address - Phone:208-367-2175
Practice Address - Fax:208-376-0285
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-2432084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1831131085Medicaid
ID1831131085Medicaid
IDH09033Medicare UPIN