Provider Demographics
NPI:1386639383
Name:DEAN, CRAIG EDWARD (PA C)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:EDWARD
Last Name:DEAN
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2943 S RUTHERFORD BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-6054
Mailing Address - Country:US
Mailing Address - Phone:615-849-3996
Mailing Address - Fax:615-849-3959
Practice Address - Street 1:2943 S RUTHERFORD BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-6054
Practice Address - Country:US
Practice Address - Phone:615-849-3996
Practice Address - Fax:615-849-3959
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000000457363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00863Medicare UPIN