Active NPI
Michael H Deshazo, MD
- Neurology Physician
- Memphis, TN
National Provider Identifier
1255320669
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- MD07728
- Practice address
- 6325 Humphreys Blvd
Memphis, TN 38120-2300 - Phone
- (901) 522-7700
- Fax
- (901) 522-2550
- NPI assigned
- Oct 18, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | MD07728 | TN | Primary |
Addresses
Primary practice location
6325 Humphreys Blvd
Memphis, TN 38120-2300
Mailing address
6325 Humphreys Blvd
Memphis, TN 38120-2300
Phone (901) 522-7700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3166245 | Medicaid | TN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 07939 | MS | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
| MD07728 | TN | MD | Neurology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129593600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1328832000000",
"number": "1255320669",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6325 HUMPHREYS BLVD",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381202300",
"telephone_number": "901-522-7700",
"fax_number": "901-522-2550"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6325 HUMPHREYS BLVD",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381202300",
"telephone_number": "901-522-7700",
"fax_number": "901-522-2550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DESHAZO",
"first_name": "MICHAEL",
"middle_name": "H",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-18",
"last_updated": "2012-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "TN",
"license": "MD07728",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3166245",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Memphis, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.