Healthcare Provider Details

I. General information

NPI: 1578784591
Provider Name (Legal Business Name): CARY SCOTT IDLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 WAKE FOREST RD STE 220
RALEIGH NC
27609-6864
US

IV. Provider business mailing address

3801 WAKE FOREST RD STE 220
RALEIGH NC
27609-6864
US

V. Phone/Fax

Practice location:
  • Phone: 919-872-5296
  • Fax: 919-850-9718
Mailing address:
  • Phone: 919-872-5296
  • Fax: 919-850-9718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number2008-00472
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA85853
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: