Provider Demographics
NPI:1376797589
Name:DEAN, THURSTON EVANS III (MD)
Entity Type:Individual
Prefix:DR
First Name:THURSTON
Middle Name:EVANS
Last Name:DEAN
Suffix:III
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 1:1310 S ALFORD ST
Mailing Address - Street 2:
Mailing Address - City:CRANE
Mailing Address - State:TX
Mailing Address - Zip Code:79731-3809
Mailing Address - Country:US
Mailing Address - Phone:903-831-7685
Mailing Address - Fax:
Practice Address - Street 1:1310 S ALFORD ST
Practice Address - Street 2:
Practice Address - City:CRANE
Practice Address - State:TX
Practice Address - Zip Code:79731-3809
Practice Address - Country:US
Practice Address - Phone:903-831-7657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3281207P00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB22169Medicare UPIN