Provider Demographics
NPI:1417148065
Name:DEAN, THAD JAMES (DO)
Entity Type:Individual
Prefix:
First Name:THAD
Middle Name:JAMES
Last Name:DEAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ORTHOPEDIC WAY
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-1629
Mailing Address - Country:US
Mailing Address - Phone:817-375-5375
Mailing Address - Fax:817-299-1706
Practice Address - Street 1:6900 HARRIS PKWY STE 310
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4261
Practice Address - Country:US
Practice Address - Phone:817-375-5200
Practice Address - Fax:817-299-1792
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA67410207X00000X
390200000X
TXP7423207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX325936801Medicaid
TX8DZ154OtherBCBS
TXP01447539OtherRAILROAD MEDICARE
TX325936801Medicaid