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Contact Information

RYAN L VAN DE GRAAFF, MD
900 N LIBERTY ST.
STE 400
BOISE, ID83704
 Phone: 208-367-3320
 Fax: 208-367-7474
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Otolaryngology

207Y00000X 04 Physician/Otolaryngology
Indicates primary specialty

NPI Profile & details for RYAN L VAN DE GRAAFF · (Male)

NPI Number 1619067436
Status Active
Credentials MD
Entity Individual
Enumeration date 10/13/2006
Last updated 06/01/2010 - About 16 years ago
Sole proprietor 1 No
Identifiers
  • ID License # M-10288
  • NE License # 22476
  • ID Medicaid 808096700
Hospital affiliation(s)
  • ST ALPHONSUS REGIONAL MEDICAL CENTER - (Acute Care)
    1055 NORTH CURTIS ROAD
    BOISE, ID 83706
  • ST LUKE'S ELMORE MEDICAL CENTER - (Critical Access)
    895 NORTH 6TH EAST
    MOUNTAIN HOME, ID 83647
  • ST LUKES REGIONAL MEDICAL CENTER - (Acute Care)
    190 EAST BANNOCK STREET
    BOISE, ID 83712
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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