Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 20217 | MS |
N | 111NI0900X | Internist | 20217 | MS |
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 55402 | TN |
N | 207RC0000X | Internist - Cardiovascular Disease | 20217 | MS |
N | 207RC0000X | Internist - Cardiovascular Disease | 55402 | TN |
NPI | 1518178441 |
---|---|
Provider Name | Dr. Matthew Denson Deshazo |
First Address | Nashville, TN 37203-5180 |
Second Address | Nashville, TN 37205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 09/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00277253 | (05) | MS |
20217 | STATE LICENSE (01) | MS |
Q026400 | (05) | TN |