Individual
MITCHELL DESHAZER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
400 N STATE OF FRANKLIN RD, ROOM 2746, JOHNSON CITY, TN 37604-6035
(423) 431-2727
(423) 431-6715
Mailing address
400 N STATE OF FRANKLIN RD, ROOM 2746, JOHNSON CITY, TN 37604-6035
(423) 431-2727
(423) 431-6715
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
51285
TN
207R00000X
Internal Medicine Physician
7932447-1205
UT
207R00000X
Internal Medicine Physician
N2058
TX
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
51285
TN
207RP1001X
Pulmonary Disease Physician
51285
TN
208M00000X
Hospitalist Physician
N2058
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023276870
—
NC
05
—
1023276870
—
VA
05
—
7100376940
—
KY
01
—
P01365055
RAILROAD MEDICARE
TN
05
—
Q007623
—
TN
Enumeration date
05/29/2008
Last updated
02/01/2017
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