Provider Demographics
NPI:1215322151
Name:BYAS, DEIDRA
Entity type:Individual
Prefix:MS
First Name:DEIDRA
Middle Name:
Last Name:BYAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10034
Mailing Address - Street 2:EDUCATION BUILDING 115
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77710-0034
Mailing Address - Country:US
Mailing Address - Phone:409-880-7949
Mailing Address - Fax:409-880-2263
Practice Address - Street 1:4400 SOUTH MARTIN LUTHER KING JR PARKWAY
Practice Address - Street 2:EDUCATION BUILDING 115
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77710-0034
Practice Address - Country:US
Practice Address - Phone:409-880-7949
Practice Address - Fax:409-880-2263
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program