Provider Demographics
NPI:1619274388
Name:DEAN MEDICAL INC
Entity Type:Organization
Organization Name:DEAN MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:RENARD
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:863-937-7157
Mailing Address - Street 1:3616 HARDEN BLVD # 311
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-5938
Mailing Address - Country:US
Mailing Address - Phone:863-937-7157
Mailing Address - Fax:863-333-0260
Practice Address - Street 1:1500 LAKELAND HILLS BLVD STE 4
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3257
Practice Address - Country:US
Practice Address - Phone:863-937-7157
Practice Address - Fax:863-333-0260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2023-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9203207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL245345600Medicaid
16757YMedicare UPIN
FL16757Medicare PIN
FL103854Medicare Oscar/Certification