Provider Demographics
NPI:1164511408
Name:DESHPANDE, PRATIBHA AMOL (MD)
Entity Type:Individual
Prefix:
First Name:PRATIBHA
Middle Name:AMOL
Last Name:DESHPANDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PRATIBHA
Other - Middle Name:SHRINIVAS
Other - Last Name:JOSHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:818 WEST FRANK STREET
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904
Mailing Address - Country:US
Mailing Address - Phone:936-699-5040
Mailing Address - Fax:936-639-8950
Practice Address - Street 1:818 WEST FRANK STREET
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904
Practice Address - Country:US
Practice Address - Phone:936-699-5040
Practice Address - Fax:936-639-8950
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8738208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
040579701OtherTPI
TX8A0024OtherBLUE CROSS
TXP08254K05Medicaid
H05470Medicare UPIN
TX8A0024OtherBLUE CROSS
8254K0Medicare ID - Type Unspecified