Provider Demographics
NPI:1871553511
Name:IRELAND, STEPHEN P (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:P
Last Name:IRELAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:208-381-2222
Mailing Address - Fax:541-389-1887
Practice Address - Street 1:520 S EAGLE RD
Practice Address - Street 2:SUITE 2207
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6351
Practice Address - Country:US
Practice Address - Phone:208-706-6300
Practice Address - Fax:208-706-7227
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM125902084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR038518Medicaid
OR038518Medicaid
ORA49614Medicare UPIN