Provider Demographics
NPI:1689667115
Name:CAREY, JOHN EDWARD (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:EDWARD
Last Name:CAREY
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 1:214 14TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:MT
Mailing Address - Zip Code:59270-3521
Mailing Address - Country:US
Mailing Address - Phone:406-488-2100
Mailing Address - Fax:864-797-6198
Practice Address - Street 1:214 14TH AVE SW
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:MT
Practice Address - Zip Code:59270-3521
Practice Address - Country:US
Practice Address - Phone:406-488-2100
Practice Address - Fax:406-488-2261
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2020-12-08
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
SC14572208600000X
MT67571208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2675Medicaid
SCGP2675Medicaid
SCSC2184B491Medicare PIN