Provider Demographics
NPI:1356312904
Name:MOUTOS, DEAN M (MD)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:M
Last Name:MOUTOS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9101 KANIS RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6417
Mailing Address - Country:US
Mailing Address - Phone:501-801-1200
Mailing Address - Fax:501-801-1207
Practice Address - Street 1:9101 KANIS RD
Practice Address - Street 2:SUITE 300
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6417
Practice Address - Country:US
Practice Address - Phone:501-801-1200
Practice Address - Fax:501-801-1207
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARC8331207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARD-35074Medicare UPIN
AR55820Medicare ID - Type Unspecified