Provider Demographics
NPI:1598942419
Name:DEIASI, DENNIS J (PA)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:J
Last Name:DEIASI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1933 NE LOOP 410
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5320
Mailing Address - Country:US
Mailing Address - Phone:210-804-6000
Mailing Address - Fax:
Practice Address - Street 1:225 E SONTERRA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3992
Practice Address - Country:US
Practice Address - Phone:210-403-2926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00618363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical