Provider Demographics
NPI:1346391513
Name:CHEYNE, STEPHEN J (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:CHEYNE
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:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:SAINT ANTHONY
Mailing Address - State:ID
Mailing Address - Zip Code:83445-0037
Mailing Address - Country:US
Mailing Address - Phone:208-624-4402
Mailing Address - Fax:208-624-4409
Practice Address - Street 1:430 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:SAINT ANTHONY
Practice Address - State:ID
Practice Address - Zip Code:83445-1425
Practice Address - Country:US
Practice Address - Phone:208-624-4402
Practice Address - Fax:208-624-4409
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM4566208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
30279OtherDMBA
ID000010001973OtherBLUE SHIELD
IDM45666OtherBLUE CROSS
30279OtherDMBA
1115464Medicare ID - Type Unspecified