Individual provider · Type 1 NPI
Ryan Joe Wallace, RT (R)
Body Imaging Physician · Moscow, ID
NPI number
1770370488
Active
Practice location
2500 W A St Ste 201
Moscow, ID 83843-6000
Mailing address
2323 Charnita Dr
Clarkston, WA 99403-1429
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Body Imaging Physician Primary | 2085B0100X | 386921 (ID) |
Body Imaging Physician: A Radiology doctor of Osteopathy that specializes in Body Imaging.
3 other providers at this address
About NPI 1770370488
Ryan Joe Wallace, RT (R)'s National Provider Identifier is 1770370488, issued on Apr 24, 2025. The primary taxonomy on file is Body Imaging Physician (2085B0100X), and the practice location is in Moscow, ID. The record was last updated on Apr 24, 2025.