Individual
RICHARD D DESHAZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
878 LAKELAND DR, LB-BUILDING, JACKSON, MS 39216-4500
(601) 815-1078
(601) 984-6994
Mailing address
878 LAKELAND DR, LB-BUILDING, JACKSON, MS 39216-4500
(601) 815-1078
(601) 984-6439
Taxonomy
Speciality
Code
Description
License number
State
207RA0201X
Allergy & Immunology (Internal Medicine) Physician
Primary
15660
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0019701
—
MS
Enumeration date
06/15/2006
Last updated
09/25/2015
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