Provider Demographics
NPI:1407379159
Name:DESJARDINS, DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:DESJARDINS
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 1:518 LINCOLNWAY ST
Mailing Address - Street 2:
Mailing Address - City:WOODBINE
Mailing Address - State:IA
Mailing Address - Zip Code:51579-1238
Mailing Address - Country:US
Mailing Address - Phone:712-647-2566
Mailing Address - Fax:712-647-2964
Practice Address - Street 1:518 LINCOLNWAY ST
Practice Address - Street 2:
Practice Address - City:WOODBINE
Practice Address - State:IA
Practice Address - Zip Code:51579-1238
Practice Address - Country:US
Practice Address - Phone:712-647-2566
Practice Address - Fax:712-647-2964
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8101207Q00000X
IAMD-47338207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine