Provider Demographics
NPI:1386290781
Name:DESHAZO MEDICAL
Entity type:Organization
Organization Name:DESHAZO MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DESHAZO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-900-4321
Mailing Address - Street 1:4387 BOULDER LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35242-2116
Mailing Address - Country:US
Mailing Address - Phone:205-492-0126
Mailing Address - Fax:
Practice Address - Street 1:4387 BOULDER LAKE CIR
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35242-2116
Practice Address - Country:US
Practice Address - Phone:205-492-0126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty