Ruby, Wayne Lavern
Ruby, Wayne Lavern is an individual health care provider with primary practice located at 623 S Main St , Moscow ID 83843-2983. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Ruby, Wayne Lavern can be contacted via phone (208) 882-2011.Contact Information
Primary practice address
623 S Main St
Moscow ID 83843-2983
Phone: (208) 882-2011
Fax: (208) 883-1853
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | M4929 | Idaho |
Profile Details
| NPI number | 1285607085 |
|---|---|
| LBN Legal business name | Ruby, Wayne Lavern |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 10th, 2006 |
| Last updated | Aug 21st, 2012 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1285607085 | NPPES |
| Idaho | MEDICAID | 003904400 |
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