Provider Demographics
NPI:1265473318
Name:DEBROEKERT, DEAN (MD)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:DEBROEKERT
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 1:1941 LIMESTONE RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5400
Mailing Address - Country:US
Mailing Address - Phone:302-998-1151
Mailing Address - Fax:302-998-1154
Practice Address - Street 1:1941 LIMESTONE RD
Practice Address - Street 2:SUITE 211
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5400
Practice Address - Country:US
Practice Address - Phone:302-998-1151
Practice Address - Fax:302-998-1154
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10003833207Q00000X
NJ25MA05482900207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0519005Medicaid
DE1000041677Medicaid
DE021315V95Medicare PIN