Provider Demographics
NPI:1699761510
Name:DESALOMS, JOHN MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
Last Name:DESALOMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8230 WALNUT HILL LN
Mailing Address - Street 2:STE 220
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4482
Mailing Address - Country:US
Mailing Address - Phone:214-750-3646
Mailing Address - Fax:214-363-2351
Practice Address - Street 1:8230 WALNUT HILL LN
Practice Address - Street 2:STE 220
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4482
Practice Address - Country:US
Practice Address - Phone:214-750-3646
Practice Address - Fax:214-363-2351
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ5562207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX043005001Medicaid
TXG71769Medicare UPIN
TX84417FMedicare PIN