Individual
EDWARD DESANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
465 MEMORIAL DR, POCATELLO, ID 83201-4008
(208) 282-4700
(208) 282-4696
Mailing address
651 MEMORIAL DR, POCATELLO, ID 83201-4071
(208) 239-2110
(208) 239-2136
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
M3307
ID
Other
Enumeration date
01/09/2007
Last updated
07/08/2007
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