Provider Demographics
NPI:1477526465
Name:DEAN, GREGORY ALAN (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALAN
Last Name:DEAN
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 S TONOPAH DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4029
Mailing Address - Country:US
Mailing Address - Phone:702-735-0006
Mailing Address - Fax:702-947-4156
Practice Address - Street 1:3980 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5102
Practice Address - Country:US
Practice Address - Phone:702-735-0006
Practice Address - Fax:702-735-2010
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV56642085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV200287801Medicaid
NV1477526465Medicaid
NV200287801Medicaid
C95951Medicare UPIN
NV105226Medicare PIN