Provider Demographics
NPI:1689412769
Name:ISAAC, DEMETRIUS SR
Entity type:Individual
Prefix:MR
First Name:DEMETRIUS
Middle Name:
Last Name:ISAAC
Suffix:SR
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 1:4835 DOVE COVE LN
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77573-7505
Mailing Address - Country:US
Mailing Address - Phone:314-807-0419
Mailing Address - Fax:
Practice Address - Street 1:4835 DOVE COVE LN
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-7505
Practice Address - Country:US
Practice Address - Phone:314-807-0419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No172A00000XOther Service ProvidersDriver
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)