Provider Demographics
NPI:1760972061
Name:DESIR, ALEXIS DANIELLE (MD)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:DANIELLE
Last Name:DESIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:DANIELLE
Other - Last Name:VICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1531 INSPIRATION DR APT 1061
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75207-3753
Mailing Address - Country:US
Mailing Address - Phone:210-632-5035
Mailing Address - Fax:
Practice Address - Street 1:5323 HARRY HINES BLVD # MC9159
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-2595
Practice Address - Country:US
Practice Address - Phone:214-648-8780
Practice Address - Fax:214-648-5250
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program