Provider Demographics
NPI:1528010022
Name:DEAN, EDWIN JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:JAMES
Last Name:DEAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 GOODLETTE RD NORTH SUITE D-306
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102
Mailing Address - Country:US
Mailing Address - Phone:239-263-0014
Mailing Address - Fax:
Practice Address - Street 1:501 GOODLETTE RD NORTH SUITE D-306
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102
Practice Address - Country:US
Practice Address - Phone:239-263-0014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME60802208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL289683OtherONE HEALTH PLAN
FL0192958OtherUNITED HEALTH CARE
FL14488OtherBLUE SHIELD
FL4226865OtherAETNA
FL057640900Medicaid
FL40916POtherBLUE CROSS
FL40916POtherBLUE CROSS
FL057640900Medicaid