Provider Demographics
NPI:1104905017
Name:DEASON, JAMES DAVID SR (RPH)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:DAVID
Last Name:DEASON
Suffix:SR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5340 PATTON CIR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75704-2002
Mailing Address - Country:US
Mailing Address - Phone:903-330-4888
Mailing Address - Fax:903-593-0031
Practice Address - Street 1:113 N NORTHWEST LOOP 323
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8725
Practice Address - Country:US
Practice Address - Phone:903-593-5369
Practice Address - Fax:903-593-3490
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18333183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX18333OtherPHARMACIST