MEDICARE: DR. STEPHEN J CARTER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	M4157	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427051747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN J CARTER M.D.

Provider Business Mailing Address
First Line	:	2001 S WOODRUFF AVE
Second Line	:	STE 3
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-6371
Country	:	US
Telephone Number	:	208-529-5909
Fax Number	:	208-529-5990

Provider Business Practice Location Address
First Line	:	2001 S WOODRUFF AVE
Second Line	:	STE 3
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-6371
Country	:	US
Telephone Number	:	208-529-5909
Fax Number	:	208-529-5990

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	09/09/2021

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