Individual
AVI DESHMUKH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
805 HILL BLVD STE 106-107, GRANBURY, TX 76048
(817) 599-3690
(817) 599-6633
Mailing address
805 HILL BLVD STE 106-107, GRANBURY, TX 76048-1481
(817) 599-3690
(817) 599-6633
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
H1067
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101878001
—
TX
01
—
111591100
FIRST CARE PROVIDER NUMBE
TX
01
—
340008824
RAILROAD MEDICARE PROV NO
TX
01
—
4458935
AETNA PROVIDER NUMBER
TX
01
—
814764
BCBS PROVIDER NUMBER
TN
01
—
9792483001
CIGNA PROVIDER NUMBER
TN
Enumeration date
06/23/2005
Last updated
06/24/2020
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