Provider Demographics
NPI:1578678066
Name:DESAIX, ANNA CHRISTINE (DPM)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:CHRISTINE
Last Name:DESAIX
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:DESAIX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:PO BOX 5105
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-5100
Mailing Address - Country:US
Mailing Address - Phone:919-220-5255
Mailing Address - Fax:
Practice Address - Street 1:120 WILLIAM PENN PLZ
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2150
Practice Address - Country:US
Practice Address - Phone:919-220-5255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005026457213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO5031350001OtherDMERC
NC614OtherMEDICAL LICENSE
MO30753578Medicaid
MOP00279397OtherRAILROAD MEDICARE
IL5031350002OtherDMERC
MO258904113Medicare PIN
IL5031350002OtherDMERC