Detar, Edward Gerard
Detar, Edward Gerard is an sole proprietor health care provider with primary practice located at 700 W Ironwood Dr Ste 341 , Coeur D Alene ID 83814-4404. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Detar, Edward Gerard can be contacted via phone (208) 625-5200.Contact Information
Primary practice address
700 W Ironwood Dr Ste 341
Coeur D Alene ID 83814-4404
Phone: (208) 625-5200
Fax: (208) 625-5201
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | M-9855 | Idaho |
Profile Details
| NPI number | 1194706465 |
|---|---|
| LBN Legal business name | Detar, Edward Gerard |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Nov 14th, 2005 |
| Last updated | Oct 2nd, 2020 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1194706465 | NPPES |
| Idaho | Other | P00448097 | RR MEDICARE |
| Idaho | MEDICAID | 1124619 | RR MEDICARE |
| Idaho | MEDICAID | 807836200 | RR MEDICARE |
| Idaho | Other | 77068 | RR MEDICARE |
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