Provider Demographics
NPI:1447227251
Name:CLEMENT, DEAN B (DPM)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:B
Last Name:CLEMENT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 E FLORENCE BLVD
Mailing Address - Street 2:STE 105
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-5334
Mailing Address - Country:US
Mailing Address - Phone:520-836-2962
Mailing Address - Fax:520-836-8343
Practice Address - Street 1:1515 E FLORENCE BLVD
Practice Address - Street 2:STE 105
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-5334
Practice Address - Country:US
Practice Address - Phone:520-836-2962
Practice Address - Fax:520-836-8343
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0593213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ934936Medicaid
AZZ113535OtherMEDICARE NUMBER ASSOCIATED GERIATRICS
V05552Medicare UPIN
103877Medicare ID - Type Unspecified
AZZ144226Medicare PIN