Provider Demographics
NPI:1508803628
Name:NEGA, DESALEGN (MD)
Entity Type:Individual
Prefix:DR
First Name:DESALEGN
Middle Name:
Last Name:NEGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E HOUSTON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BEEVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78102-5313
Mailing Address - Country:US
Mailing Address - Phone:361-358-0034
Mailing Address - Fax:361-362-1717
Practice Address - Street 1:1600 E HOUSTON ST
Practice Address - Street 2:SUITE A
Practice Address - City:BEEVILLE
Practice Address - State:TX
Practice Address - Zip Code:78102-5313
Practice Address - Country:US
Practice Address - Phone:361-358-0034
Practice Address - Fax:361-362-1717
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2233208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1779720Medicaid
TX095059402Medicaid
TX0044AZMedicare ID - Type UnspecifiedGROUP NUMBER
TXI46428Medicare UPIN
TX095059402Medicaid