Healthcare Provider Details

I. General information

NPI: 1861874323
Provider Name (Legal Business Name): ALEJANDRO SANTIAGO TOSCANO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2015
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 S 7TH ST
ST MARIES ID
83861-1803
US

IV. Provider business mailing address

229 S 7TH ST
ST MARIES ID
83861-1803
US

V. Phone/Fax

Practice location:
  • Phone: 208-245-5551
  • Fax: 208-245-5246
Mailing address:
  • Phone: 208-245-5551
  • Fax: 208-245-5246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number1471255
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberR0146
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR0146
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number1471255
License Number StateID
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1471255
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: