Provider Demographics
NPI:1003856576
Name:LUSARDI, DEAN A (MD)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:A
Last Name:LUSARDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7703 FLOYD CURL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-450-9300
Mailing Address - Fax:
Practice Address - Street 1:8300 FLOYD CURL DR FL 3
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3931
Practice Address - Country:US
Practice Address - Phone:210-450-9300
Practice Address - Fax:210-450-6023
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000156464207X00000X
MN107013207X00000X
TXQ8291207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
200039419OtherRAILROAD MEDICARE
TX359244601Medicaid
TX359244602OtherCSHCN
MO205095102Medicaid
TX359244601Medicaid
TX505985YK00Medicare UPIN
G38877Medicare UPIN