Provider Demographics
NPI:1669474623
Name:DESHAZO, FLINT K (MD)
Entity Type:Individual
Prefix:DR
First Name:FLINT
Middle Name:K
Last Name:DESHAZO
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 1:7200 WYOMING SPGS
Mailing Address - Street 2:STE 600
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4305
Mailing Address - Country:US
Mailing Address - Phone:512-244-1995
Mailing Address - Fax:512-244-2090
Practice Address - Street 1:7200 WYOMING SPGS
Practice Address - Street 2:STE 600
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4305
Practice Address - Country:US
Practice Address - Phone:512-244-1995
Practice Address - Fax:512-244-2090
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-02
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0291207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136201403Medicaid
TX2930473005OtherFKD CIGNA HMO
TX7566001OtherFKD AETNA PPO
TX86V632OtherFKD BLUE HMO
TX080152577OtherFKD RRB MEDICARE UNIT
TX2930473006OtherFKD CIGNA PPO
TX742690907OtherFKD ST D PPO
TX819464OtherFKD FH PPO
TX7566001OtherFKD AETNA HMO
TX86V632OtherFKS OLD HMO BLUE
TX86V632OtherFKD BLUE PPO
TX742690907OtherFKD ST D PPO
TX86V632OtherFKD BLUE PPO