Healthcare Provider Details

I. General information

NPI: 1710477500
Provider Name (Legal Business Name): CRAIG G STEINER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 CRESTWOOD LN
IDAHO FALLS ID
83404-4979
US

IV. Provider business mailing address

3820 CRESTWOOD LN
IDAHO FALLS ID
83404-4979
US

V. Phone/Fax

Practice location:
  • Phone: 208-552-7700
  • Fax: 208-552-1786
Mailing address:
  • Phone: 208-552-7700
  • Fax: 208-552-1786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11390481-1205
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM-15687
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: