Edward Desano, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

M3307 Issued in ID

Practice address

465 Memorial Dr
Pocatello, ID 83201-4008

Phone

(208) 282-4700

Fax

(208) 282-4696

NPI assigned

Jan 9, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Edward a Desano Jr MD PA

  • Obstetrics & Gynecology Physician
  • Pocatello, ID
  • NPI 1821127077
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1831248962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "651 MEMORIAL DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014071",
            "telephone_number": "208-239-2110",
            "fax_number": "208-239-2136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "465 MEMORIAL DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014008",
            "telephone_number": "208-282-4700",
            "fax_number": "208-282-4696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESANO",
        "first_name": "EDWARD",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M3307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dentistry for Kids PLLC
• David M Denton, M.D.
• Denture Arts, Inc.
• Denture Clinic of Pocatello, Inc.
• Aneree H Desai, M.D
• Mikayla Louise Deschamps
• Deseret Care, LLC
• Desert Valley Dentistry
• Nancy L Devine, P.T.
• Cara Devoe, DPT

• Family Medicine Physician in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Family Medicine Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.