Basic Information
| Provider Information | |||||||||
| NPI: | 1578784591 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IDLER | ||||||||
| FirstName: | CARY | ||||||||
| MiddleName: | SCOTT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3801 WAKE FOREST RD STE 220 | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276096864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198725296 | ||||||||
| FaxNumber: | 9198509718 | ||||||||
| Practice Location | |||||||||
| Address1: | 3801 WAKE FOREST RD STE 220 | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276096864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198725296 | ||||||||
| FaxNumber: | 9198509718 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2007 | ||||||||
| LastUpdateDate: | 01/08/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0117X | 2008-00472 | NC | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine | 207X00000X | A85853 | CA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.