Richard D Deshazo, MD

Primary specialty

Allergy & Immunology (Internal Medicine) PhysicianTaxonomy code 207RA0201X

License

15660 Issued in MS

Practice address

878 Lakeland Dr
LB-Building
Jackson, MS 39216-4500

Phone

(601) 815-1078

Fax

(601) 984-6994

NPI assigned

Jun 15, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• University Internal Medicine Assoc LLP

  • Internal Medicine Physician
  • Jackson, MS
  • NPI 1083656870
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443139200000",
    "number": "1225072838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "878 LAKELAND DR",
            "address_2": "LB-BUILDING",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-815-1078",
            "fax_number": "601-984-6439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "878 LAKELAND DR",
            "address_2": "LB-BUILDING",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-815-1078",
            "fax_number": "601-984-6994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESHAZO",
        "first_name": "RICHARD",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-15",
        "last_updated": "2015-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RA0201X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Allergy & Immunology",
            "state": "MS",
            "license": "15660",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0019701",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Derrick, FNP-C
• Taylor Lynn Derrico, PA-C
• Jagdish Desai, M.D.
• Shivum Kumar Desai
• Smruti Pranav Desai, MD
• Lisa Marie Desselles, LCSW
• Destin Healthcare Inc
• Destin Healthcare Inc
• Courtney Paige Detwiler
• Taylor Deushane, DO

• Allergy & Immunology (Internal Medicine) Physician in Jackson, MS
• Providers in Jackson, MS by specialty
• Allergy & Immunology (Internal Medicine) Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.