1790744811 NPI number — DAVID PAUL DEAN MD

Table of content: DAVID PAUL DEAN MD (NPI 1790744811)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790744811 NPI number — DAVID PAUL DEAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEAN
Provider First Name:
DAVID
Provider Middle Name:
PAUL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DEAN
Provider Other First Name:
DAVID
Provider Other Middle Name:
PAUL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1790744811
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1368
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUSTANG
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73064-8368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-745-9600
Provider Business Mailing Address Fax Number:
405-745-9602

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 SAINT VINCENT CIR
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72205-5405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-552-2660
Provider Business Practice Location Address Fax Number:
501-552-4549
Provider Enumeration Date:
03/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X , with the licence number:  C7913 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 131637001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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