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Individual

RAYMOND DALE DESHAZER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
ATP

Contact information

Practice address
2001 108TH ST, STE 104, GRAND PRAIRIE, TX 75050-1437
(214) 677-0186
(214) 677-0157
Mailing address
1200 RED HAWK BAY DR, WEST TAWAKONI, TX 75474-4530
(469) 877-8113
(214) 677-0157

Taxonomy

Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
ATP88264
TX

Other

Enumeration date
05/11/2017
Last updated
05/11/2017
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