Basic Information
| Provider Information | |||||||||
| NPI: | 1063465938 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STEIN | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2069 | ||||||||
| Address2: | |||||||||
| City: | EUREKA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 599172069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062973145 | ||||||||
| FaxNumber: | 4062973364 | ||||||||
| Practice Location | |||||||||
| Address1: | 304 OSLOSKI RD | ||||||||
| Address2: | |||||||||
| City: | EUREKA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 599179217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062973145 | ||||||||
| FaxNumber: | 4062973364 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 04/20/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 8260 | MT | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1063465938 | 01 | MT | BCBS | OTHER | 1063465938 | 05 | MT | MEDICAID |