Provider Demographics
NPI:1881323178
Name:RIZ, PETER MICHAEL (PA-S)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:MICHAEL
Last Name:RIZ
Suffix:
Gender:M
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1330
Mailing Address - Street 2:
Mailing Address - City:CASCADE
Mailing Address - State:ID
Mailing Address - Zip Code:83611-1330
Mailing Address - Country:US
Mailing Address - Phone:208-382-4242
Mailing Address - Fax:
Practice Address - Street 1:454 W. ROSEBERRY RD
Practice Address - Street 2:SUITE 103
Practice Address - City:DONNELLY
Practice Address - State:ID
Practice Address - Zip Code:83615-0000
Practice Address - Country:US
Practice Address - Phone:208-382-4285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
IDPA-2711363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant