Provider Demographics
NPI:1871536243
Name:COLE, RYAN N (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:N
Last Name:COLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7988 W. MARIGOLD ST.
Mailing Address - Street 2:STE. 150
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714
Mailing Address - Country:US
Mailing Address - Phone:208-472-1082
Mailing Address - Fax:208-472-1078
Practice Address - Street 1:7988 W. MARIGOLD ST.
Practice Address - Street 2:STE. 150
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714
Practice Address - Country:US
Practice Address - Phone:208-472-1072
Practice Address - Fax:208-472-1078
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM8883207ZP0102X, 246Q00000X
IDM-8883207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No246Q00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1400759Medicare ID - Type Unspecified
G84249Medicare UPIN