Basic Information
| Provider Information | |||||||||
| NPI: | 1518178441 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DESHAZO | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | DENSON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 20TH AVE N STE 403 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372035180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152847260 | ||||||||
| FaxNumber: | 6152847501 | ||||||||
| Practice Location | |||||||||
| Address1: | 4230 HARDING PIKE | ||||||||
| Address2: | SUITE 330 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152694545 | ||||||||
| FaxNumber: | 6155656789 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2007 | ||||||||
| LastUpdateDate: | 07/09/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RA0001X | 55402 | TN | Y | 207R00000X | 20217 | MS | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | 20217 | MS | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | 55402 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 20217 | 01 | MS | STATE LICENSE | OTHER | 00277253 | 05 | MS | MEDICAID | Q026400 | 05 | TN | MEDICAID |