Individual
DR. EDWARD GERARD DETAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
700 W IRONWOOD DR STE 341, COEUR D ALENE, ID 83814-4404
(208) 625-5200
(208) 625-5201
Mailing address
700 W IRONWOOD DR, SUITE 304, COEUR D ALENE, ID 83814-2656
(208) 625-5200
(208) 625-5201
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
M-9855
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124619
—
WA
01
—
77068
BC ID
ID
05
—
807836200
—
ID
01
—
P00448097
RR MEDICARE
ID
Enumeration date
11/14/2005
Last updated
04/14/2025
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