Provider Demographics
NPI:1033422183
Name:DEGAZON, YVETTE J (MD)
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:J
Last Name:DEGAZON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 STUDEWOOD ST
Mailing Address - Street 2:SUITE 200B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-7190
Mailing Address - Country:US
Mailing Address - Phone:713-363-9830
Mailing Address - Fax:713-426-1848
Practice Address - Street 1:1001 STUDEWOOD ST
Practice Address - Street 2:SUITE 200B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-7190
Practice Address - Country:US
Practice Address - Phone:713-363-9830
Practice Address - Fax:713-426-1848
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXQ4084207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8FM155OtherBLUE CROSS BLUE SHIELD
LA2129341Medicaid
TX8FT263OtherBLUE CROSS BLUE SHIELD
LA2129341Medicaid
TX459103YMVQMedicare PIN
TX459103ZSWDMedicare PIN