Provider Demographics
NPI:1659373546
Name:LEY, CARL E (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:E
Last Name:LEY
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 1829
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83816-1829
Mailing Address - Country:US
Mailing Address - Phone:208-667-9334
Mailing Address - Fax:208-664-2341
Practice Address - Street 1:700 W IRONWOOD DR
Practice Address - Street 2:SUITE 110
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2656
Practice Address - Country:US
Practice Address - Phone:208-666-3200
Practice Address - Fax:208-666-3217
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM54342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8136269Medicaid
IDD8728OtherBC ID - CDA
ID54346OtherBC ID - RANI
IDP00093831OtherRR MEDICARE - RANI
ID1121411OtherCIGNA MEDICARE - RANI
IDB1287OtherBC ID - PF
D93319Medicare UPIN
ID1121411OtherCIGNA MEDICARE - RANI