Deshazo, Richard D

Deshazo, Richard D is an individual health care provider with primary practice located at 878 Lakeland Dr Lb-Building, Jackson MS 39216-4500. He recently has only one registered license in Allopathic & Osteopathic Physicians / Allergy & Immunology, which is considered as his primary health care specialty. Deshazo, Richard D can be contacted via phone (601) 815-1078.

Contact Information

Primary practice address
878 Lakeland Dr Lb-Building Jackson MS 39216-4500
Phone: (601) 815-1078
Fax: (601) 984-6994
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Allergy & Immunology 207RA0201X 15660 Mississippi

Profile Details

NPI number 1225072838
LBN Legal business name Deshazo, Richard D
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 15th, 2006
Last updated Sep 25th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1225072838 NPPES
Mississippi MEDICAID 0019701

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