Provider Demographics
NPI:1114103058
Name:MELISSA ANN DEAN MD PL
Entity Type:Organization
Organization Name:MELISSA ANN DEAN MD PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-584-1212
Mailing Address - Street 1:1345 36TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4811
Mailing Address - Country:US
Mailing Address - Phone:772-567-1500
Mailing Address - Fax:772-567-1505
Practice Address - Street 1:1345 36TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4811
Practice Address - Country:US
Practice Address - Phone:772-567-1500
Practice Address - Fax:772-567-1505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98123207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME98123OtherMEDICAL LICENSE
FLME98123OtherMEDICAL LICENSE