Provider Demographics
NPI:1376639310
Name:DEAN, WILLARD HOWELL (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLARD
Middle Name:HOWELL
Last Name:DEAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:73 SABINO GONZALES ROAD
Mailing Address - Street 2:
Mailing Address - City:GLORIETA
Mailing Address - State:NM
Mailing Address - Zip Code:87535
Mailing Address - Country:US
Mailing Address - Phone:505-983-1120
Mailing Address - Fax:505-757-6465
Practice Address - Street 1:73 SABINO GONZALES ROAD
Practice Address - Street 2:
Practice Address - City:GLORIETA
Practice Address - State:NM
Practice Address - Zip Code:87535
Practice Address - Country:US
Practice Address - Phone:505-983-1120
Practice Address - Fax:505-757-6465
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM81181208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
D35595Medicare UPIN