Healthcare Provider Details

I. General information

NPI: 1669474623
Provider Name (Legal Business Name): FLINT K DESHAZO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2005
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 WYOMING SPGS STE 600
ROUND ROCK TX
78681-4305
US

IV. Provider business mailing address

7200 WYOMING SPGS STE 600
ROUND ROCK TX
78681-4305
US

V. Phone/Fax

Practice location:
  • Phone: 512-244-1995
  • Fax: 877-215-6813
Mailing address:
  • Phone: 512-244-1995
  • Fax: 512-244-2090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH0291
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: