Provider Demographics
NPI:1740346071
Name:DESHAZO, ROSEMARY ANN (MD)
Entity type:Individual
Prefix:DR
First Name:ROSEMARY
Middle Name:ANN
Last Name:DESHAZO
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 1:755 WINDSOR ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-3614
Mailing Address - Country:US
Mailing Address - Phone:801-520-1403
Mailing Address - Fax:
Practice Address - Street 1:50 N 1900 E
Practice Address - Street 2:UNIV OF UTAH INTERNAL MEDICINE DEPT, SOM 4C104
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-581-7606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6020020-1205207R00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine