Provider Demographics
NPI:1740567551
Name:IDLER SPINE, PLLC
Entity Type:Organization
Organization Name:IDLER SPINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARY
Authorized Official - Middle Name:S
Authorized Official - Last Name:IDLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-872-5296
Mailing Address - Street 1:3410 EXECUTIVE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7450
Mailing Address - Country:US
Mailing Address - Phone:919-872-5296
Mailing Address - Fax:919-850-9718
Practice Address - Street 1:3410 EXECUTIVE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7450
Practice Address - Country:US
Practice Address - Phone:919-872-5296
Practice Address - Fax:919-850-9718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-00472207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty