Provider Demographics
NPI:1134170855
Name:RIRIE, MARNIE R (MD)
Entity type:Individual
Prefix:
First Name:MARNIE
Middle Name:R
Last Name:RIRIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 S HADLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-2684
Mailing Address - Country:US
Mailing Address - Phone:208-209-7898
Mailing Address - Fax:208-258-2079
Practice Address - Street 1:1636 HADLEY AVE.
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709
Practice Address - Country:US
Practice Address - Phone:208-258-2078
Practice Address - Fax:208-258-2079
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-9342207N00000X
IDM9342207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine