Individual
MOLLIE RENE DESHAZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
619 19TH STREET SOUTH, BIRMINGHAM, AL 35233
(205) 934-6600
Mailing address
PO BOX 55310, BIRMINGHAM, AL 35255-5310
(205) 731-9701
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
24415
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009936801
—
AL
05
—
009936802
—
AL
05
—
009936803
—
AL
01
—
051534114
BCBS
AL
01
—
051534115
BCBS
AL
01
—
051534116
BCBS
AL
01
—
P00376923
RAILROAD MEDICARE
AL
Enumeration date
05/10/2006
Last updated
10/20/2011
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