Provider Demographics
NPI:1164574372
Name:GERMANO, FRANK ALAN (MD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:ALAN
Last Name:GERMANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 E CHINDEN BLVD
Mailing Address - Street 2:#115-523
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6763
Mailing Address - Country:US
Mailing Address - Phone:208-321-9550
Mailing Address - Fax:208-323-9070
Practice Address - Street 1:7267 POTOMAC DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9150
Practice Address - Country:US
Practice Address - Phone:208-321-9550
Practice Address - Fax:208-323-9070
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM60222084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDDJ806OtherBLUE CROSS OF IDAHO
ID000222600Medicaid
ID000010001101OtherREGENCE BLUE SHIELD
1126026Medicare ID - Type Unspecified
E13625Medicare UPIN