Provider Demographics
NPI:1497894562
Name:DEAN, BRIAN S (DO, FACOEP)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:S
Last Name:DEAN
Suffix:
Gender:M
Credentials:DO, FACOEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23321
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-4321
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14 RICHLAND MEDICAL PARK DR STE 350
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6896
Practice Address - Country:US
Practice Address - Phone:803-434-1663
Practice Address - Fax:803-434-3897
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036142138207P00000X
MI5101016354207P00000X
OH34.012785207P00000X
WI52768-21207P00000X
WV3772207P00000X
SC37756207P00000X
IN02003684A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine