Provider Demographics
NPI:1417976945
Name:DEAN, ROYAL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROYAL
Middle Name:
Last Name:DEAN
Suffix:
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 1:1129 RED TAIL WAY
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-7232
Mailing Address - Country:US
Mailing Address - Phone:805-522-6222
Mailing Address - Fax:805-577-0559
Practice Address - Street 1:1687 ERRINGER RD STE 217
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-6510
Practice Address - Country:US
Practice Address - Phone:805-577-0059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG063880208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA110237972OtherRAIL ROAD MEDICARE
CA110237972OtherRAIL ROAD MEDICARE
CA110237972OtherRAIL ROAD MEDICARE
CAE79795Medicare UPIN