Provider Demographics
NPI:1124277629
Name:DESHIELDS, DENISE LAVETTE (MD)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:LAVETTE
Last Name:DESHIELDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 STATE JAIL RD
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-8465
Mailing Address - Country:US
Mailing Address - Phone:915-849-8039
Mailing Address - Fax:915-849-8465
Practice Address - Street 1:3901 STATE JAIL RD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-8465
Practice Address - Country:US
Practice Address - Phone:915-849-8039
Practice Address - Fax:915-849-8465
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5162208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice