Individual
DOUGLAS P DERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2003 KOOTENAI HEALTH WAY, COEUR D ALENE, ID 83814-6051
(208) 666-2000
(208) 666-3963
Mailing address
2003 KOOTENAI HEALTH WAY, COEUR D ALENE, ID 83814-6051
(208) 666-2000
(208) 666-3963
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
042
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004000800
—
ID
01
—
S5312
BLUE CROSS
ID
Enumeration date
08/23/2005
Last updated
02/23/2010
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