Provider Demographics
NPI:1518956135
Name:DEAN, DEWEY L (MD, PHD)
Entity Type:Individual
Prefix:
First Name:DEWEY
Middle Name:L
Last Name:DEAN
Suffix:
Gender:M
Credentials:MD, PHD
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 22408
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-0408
Mailing Address - Country:US
Mailing Address - Phone:270-366-0755
Mailing Address - Fax:314-846-0635
Practice Address - Street 1:810 EAST VINE STREET
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071
Practice Address - Country:US
Practice Address - Phone:270-762-1100
Practice Address - Fax:270-752-2290
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29181207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64088081Medicaid
KY000000337245OtherBCBS KY PIN
KYP00146132OtherMEDICARE RAILROAD
KY000000337245OtherBCBS KY PIN
KY64088081Medicaid