Provider Demographics
NPI:1740819408
Name:WHORTON, DEION ANDRE
Entity type:Individual
Prefix:MR
First Name:DEION
Middle Name:ANDRE
Last Name:WHORTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 WESTHEIMER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-5597
Mailing Address - Country:US
Mailing Address - Phone:317-964-1955
Mailing Address - Fax:
Practice Address - Street 1:5100 WESTHEIMER RD STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-5597
Practice Address - Country:US
Practice Address - Phone:317-964-1955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-05
Last Update Date:2020-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX850565656Medicaid