Ryan T Mcculloch, PA

NPI #1720195530 in Chubbuck, Idaho

Provider Information

NPI Number: 1720195530
Entity Type: Individual
Name: Ryan T Mcculloch, PA
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA
Enumeration Date: Aug 25, 2006
Last Updated: Dec 20, 2010

Practice Location

Address: 147 W CHUBBUCK RD
City: Chubbuck
State: Idaho
ZIP Code: 83202-2314
Phone: (208) 238-7546

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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