Provider Demographics
NPI:1013977297
Name:SETSER, EDWARD R (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:R
Last Name:SETSER
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:PO BOX 277381
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-7381
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3200 CHANNING WAY STE A205
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7586
Practice Address - Country:US
Practice Address - Phone:208-535-4580
Practice Address - Fax:208-535-4520
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34713208G00000X
IDM12737208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0129142000Medicaid
WV550357050OtherUNITED MINE WORKERS
WV000023797OtherBCBS MOUNTAIN STATE
WV030028200OtherBLACK LUNG
OH0289272Medicaid
KY64942469Medicaid
OH0289272Medicaid
WV0129142000Medicaid
WV550357050OtherUNITED MINE WORKERS
KY64942469Medicaid