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Organization
EDWARD A DESANO JR MD PA
Active
Organization
EDWARD A DESANO JR MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARSHA DESANO (OFFICE MANAGER)
(208) 251-6690
Entity
Organization
Contact information
Practice address
755 HOSPITAL WAY, B 2, POCATELLO, ID 83201-2717
(208) 232-0581
Mailing address
2110 N MINK CREEK RD, POCATELLO, ID 83204-7207
(208) 251-6690
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
M-3307
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0002460200
—
ID
Enumeration date
03/05/2007
Last updated
08/22/2020
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