Provider Demographics
NPI:1043282528
Name:DEAN, DAVID JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOSEPH
Last Name:DEAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 MAR WALT DR UNIT 100
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6637
Mailing Address - Country:US
Mailing Address - Phone:850-863-2153
Mailing Address - Fax:850-863-8085
Practice Address - Street 1:1034 MAR WALT DR UNIT 100
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6637
Practice Address - Country:US
Practice Address - Phone:850-863-2153
Practice Address - Fax:850-863-8085
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014684207X00000X
OH58.001446207X00000X
FLOS13435207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL67VUROtherBCBS FL
FL11976548OtherCAQH
FL016754100Medicaid