Provider Demographics
NPI:1255838736
Name:DESHOTELS, MATTHEW RISHER
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:RISHER
Last Name:DESHOTELS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2455 DUNSTAN RD APT 164
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-2302
Mailing Address - Country:US
Mailing Address - Phone:318-201-5002
Mailing Address - Fax:
Practice Address - Street 1:2455 DUNSTAN RD APT 164
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-2302
Practice Address - Country:US
Practice Address - Phone:318-201-5002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program