Provider Demographics
NPI:1629150123
Name:KIERAN, STUART NEIL (MD)
Entity type:Individual
Prefix:
First Name:STUART
Middle Name:NEIL
Last Name:KIERAN
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 1:1601 CLINT MOORE RD #120
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-5712
Mailing Address - Country:US
Mailing Address - Phone:406-375-9310
Mailing Address - Fax:406-375-9305
Practice Address - Street 1:1601 CLINT MOORE RD #120
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-5712
Practice Address - Country:US
Practice Address - Phone:561-939-0300
Practice Address - Fax:561-939-0339
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT102722084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0064740Medicaid
MT000095765OtherBLUE CROSS BLUE SHIELD
E43749Medicare UPIN
MT000095765OtherBLUE CROSS BLUE SHIELD