Provider Demographics
NPI:1598793176
Name:DEAN, W. MARK (MD)
Entity Type:Individual
Prefix:
First Name:W.
Middle Name:MARK
Last Name:DEAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:MARK
Other - Last Name:DEAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1200 HILYARD ST
Mailing Address - Street 2:SUITE S-460
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-8122
Mailing Address - Country:US
Mailing Address - Phone:541-685-1794
Mailing Address - Fax:541-686-3942
Practice Address - Street 1:1162 WILLAMETTE ST
Practice Address - Street 2:ATTN: CAROL CRAYS
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3568
Practice Address - Country:US
Practice Address - Phone:541-687-6373
Practice Address - Fax:541-434-3164
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD264042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR270821Medicaid
OR270821Medicaid
134220Medicare ID - Type Unspecified