Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Ryan Joe Wallace, RTR

Individual provider Body Imaging Physician · NPI 1770370488

Ryan Joe Wallace, RTR is a Body Imaging Physician in Moscow, Idaho. Practices as a sole proprietor. Licensed in Idaho.

Licensed in
ID
In the registry since
2025

Practice location Address checks out

2500 W A St Ste 201
Moscow, ID 83843-6000
Phone: (208) 596-8408
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Body Imaging Physician (primary) Taxonomy 2085B0100X · Licence 386921 (ID)

Record details

NPI number1770370488
Entity typeIndividual (Type 1)
GenderMale
Credentials RTR
Sole proprietorYes
NPI enumeratedApril 24, 2025
Last updated in NPPESApril 24, 2025
Certification dateApril 24, 2025
Mailing address2323 Charnita Dr, Clarkston, WA 99403-1429