Provider Demographics
NPI:1720181639
Name:CARRINGTON, STEWART G (MD)
Entity type:Individual
Prefix:
First Name:STEWART
Middle Name:G
Last Name:CARRINGTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 S. DAISY ST
Mailing Address - Street 2:
Mailing Address - City:SALMON
Mailing Address - State:ID
Mailing Address - Zip Code:83467-0000
Mailing Address - Country:US
Mailing Address - Phone:208-756-5600
Mailing Address - Fax:208-756-4169
Practice Address - Street 1:203 S DAISY
Practice Address - Street 2:
Practice Address - City:SALMON
Practice Address - State:ID
Practice Address - Zip Code:83467-0000
Practice Address - Country:US
Practice Address - Phone:208-756-5600
Practice Address - Fax:208-756-4169
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-5749208600000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002132700Medicaid
1124209Medicare ID - Type Unspecified
C71844Medicare UPIN