Provider Demographics
NPI:1073924361
Name:DEFREES, DEAN NATHANIAL (MD)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:NATHANIAL
Last Name:DEFREES
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 1:3950 17TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-1300
Mailing Address - Country:US
Mailing Address - Phone:541-523-1001
Mailing Address - Fax:541-523-1152
Practice Address - Street 1:3950 17TH ST STE A
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-1300
Practice Address - Country:US
Practice Address - Phone:541-523-1001
Practice Address - Fax:541-523-1152
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMRM-1392207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine