Provider Demographics
NPI:1518004209
Name:DEAN, HERSCHEL B (MD)
Entity Type:Individual
Prefix:DR
First Name:HERSCHEL
Middle Name:B
Last Name:DEAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18901 GREENWELL SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:GREENWELL SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70739-4836
Mailing Address - Country:US
Mailing Address - Phone:225-924-9985
Mailing Address - Fax:225-924-0884
Practice Address - Street 1:18901 GREENWELL SPRINGS RD
Practice Address - Street 2:
Practice Address - City:GREENWELL SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70739-4836
Practice Address - Country:US
Practice Address - Phone:225-924-9985
Practice Address - Fax:225-924-0884
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA010977207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1103039Medicaid
LA010977OtherSTATE LICENSE
LA5B061Medicare ID - Type UnspecifiedGROUP MEDICARE
LA1103039Medicaid
LAB62952Medicare UPIN