Provider Demographics
NPI:1457300279
Name:CARRIGAN, BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:CARRIGAN
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 1:98 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-1758
Mailing Address - Country:US
Mailing Address - Phone:208-785-5801
Mailing Address - Fax:208-785-3504
Practice Address - Street 1:326 POPLAR ST
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-1741
Practice Address - Country:US
Practice Address - Phone:208-785-5801
Practice Address - Fax:208-785-3504
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-5414207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010002534OtherREGENCE BLUE SHIELD
ID76963OtherBLUE CROSS
ID74161OtherBLUE CROSS OLD
ID313146OtherALTIUS
ID003646800Medicaid
ID266529OtherALTIUS OLD
ID74161OtherBLUE CROSS OLD
ID313146OtherALTIUS
ID80028117Medicare PIN
ID1120434Medicare PIN
ID1120436Medicare PIN