Individual
DR. MARK GREGORY DESAUTEL
Active
Individual
DR. MARK GREGORY DESAUTEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
4246
SD
207YP0228X
Pediatric Otolaryngology Physician
4246
SD
207YS0123X
Facial Plastic Surgery Physician
4246
SD
207YX0602X
Otolaryngic Allergy Physician
4246
SD
207YX0901X
Otology & Neurotology Physician
4246
SD
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
4246
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1986174
—
IA
01
—
4996176
BLUE SHIELD
SD
05
—
6520242
—
SD
05
—
8015163000
—
MN
Enumeration date
07/07/2005
Last updated
06/11/2014
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