Basic Information
| Provider Information | |||||||||
| NPI: | 1164574372 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GERMANO | ||||||||
| FirstName: | FRANK | ||||||||
| MiddleName: | ALAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3210 E CHINDEN BLVD | ||||||||
| Address2: | #115-523 | ||||||||
| City: | EAGLE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836166763 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083219550 | ||||||||
| FaxNumber: | 2083239070 | ||||||||
| Practice Location | |||||||||
| Address1: | 7267 POTOMAC DR | ||||||||
| Address2: | |||||||||
| City: | BOISE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 837049150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2083219550 | ||||||||
| FaxNumber: | 2083239070 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2007 | ||||||||
| LastUpdateDate: | 02/05/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0805X | M6022 | ID | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Geriatric Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | DJ806 | 01 | ID | BLUE CROSS OF IDAHO | OTHER | 000222600 | 05 | ID | MEDICAID | 000010001101 | 01 | ID | REGENCE BLUE SHIELD | OTHER |