NPI age
1 years
Enumerated 2025-04-24
● Active
Type 1 · Individual
Ryan Joe Wallace, RT (R)
Wallace is 1 of 1 radiology providers in Moscow and 1 of 7 in Idaho.
Primary specialty
Radiology
Licensed in
ID
1 state
Status
Active
No deactivations on record
Last NPPES update
2025-04-24
Source: monthly bulk 2026-05
Sole proprietor
Yes
Solo practice on file
How this provider compares
Across 7 active radiology providers in Idaho.
NPI age
1 years
↓ 16 yr below median (17 yr)
State licenses
1 state
0% of peers hold multiple states
Subspecialties
0
14% of peers hold subspecialties
NPI lifetime · 2025 → 2026
2025-04Enumerated in NPPES
2025
2026
Where they practice
Practice location
2500 W A St Ste 201
Moscow, ID 838436000
Mailing address
2323 Charnita Dr
Clarkston, WA 994031429
Specialties
-
Radiology PrimaryA Radiology doctor of Osteopathy that specializes in Body Imaging.
Practice context
Part of a multi-provider practice. 3 other active providers share this practice address in NPPES.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
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