IndividualActive
Ryan Wallace, RT (R)
NPI 1770370488 · Body Imaging Physician · Moscow, ID
Provider details
- NPI number
- 1770370488
- Entity type
- Individual
- Primary specialty
- Body Imaging PhysicianAllopathic & Osteopathic Physicians
- Credential
- RT (R)
- Sex
- Male
- Sole proprietor
- Yes
- License
- 386921 (ID)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
2500 W a St Ste 201
Moscow, ID 83843-6000
Phone: (208) 596-8408
Approximate (ZIP-level) locationGet directions
Mailing address
2323 Charnita Dr
Clarkston, WA 99403-1429
Registry dates
- Enumerated
- 2025-04-24
- Last updated
- 2025-04-24
- Certified
- 2025-04-24
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.