1386737989 NPI number — G ADRIAN DEAN MD INC

Table of content: (NPI 1386737989)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386737989 NPI number — G ADRIAN DEAN MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
G ADRIAN DEAN MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386737989
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
709 CANYON PARK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TWIN FALLS
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83301-3054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-944-4727
Provider Business Mailing Address Fax Number:
208-944-4646

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
709 CANYON PARK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TWIN FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83301-3054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-944-4727
Provider Business Practice Location Address Fax Number:
208-944-4646
Provider Enumeration Date:
10/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DEAN
Authorized Official First Name:
G.
Authorized Official Middle Name:
ADRIAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
208-944-4727

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  M-5018 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8E787 . This is a "BLUE CROSS" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".