Provider Demographics
NPI:1205293305
Name:ISOM, DEMETRIUS
Entity type:Individual
Prefix:MR
First Name:DEMETRIUS
Middle Name:
Last Name:ISOM
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 1:12623 LAKE DENISE BLVD
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-7510
Mailing Address - Country:US
Mailing Address - Phone:352-432-2230
Mailing Address - Fax:352-432-2230
Practice Address - Street 1:12623 LAKE DENISE BLVD
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-7510
Practice Address - Country:US
Practice Address - Phone:352-432-2230
Practice Address - Fax:352-432-2230
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst