Provider Demographics
NPI:1164432555
Name:DEAR, HOWARD D (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:D
Last Name:DEAR
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 1:401 BAPTIST DR
Mailing Address - Street 2:#304
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-2009
Mailing Address - Country:US
Mailing Address - Phone:601-605-3531
Mailing Address - Fax:601-605-3532
Practice Address - Street 1:401 BAPTIST DR
Practice Address - Street 2:#304
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-2009
Practice Address - Country:US
Practice Address - Phone:601-605-3531
Practice Address - Fax:601-605-3532
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS04974207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS4239272OtherAETNA
MS00115735Medicaid
MS753068151011OtherTRICARE
MSP00417794OtherRR MEDICARE
MSB30169Medicare UPIN