Provider Demographics
NPI:1629020136
Name:SCHANEN, DEAN EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:EDWARD
Last Name:SCHANEN
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:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-2111
Mailing Address - Fax:
Practice Address - Street 1:5245 W HIGHWAY 290
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8963
Practice Address - Country:US
Practice Address - Phone:512-654-2100
Practice Address - Fax:512-654-2101
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2787207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX045062909Medicaid
TX045062907Medicaid
TX045062910Medicaid
TX045062903Medicaid
TXP00118955OtherRAILROAD MEDICARE
TX045062905Medicaid
TX88049NMedicare PIN
TX045062907Medicaid
TXP00118955OtherRAILROAD MEDICARE
TXH21348Medicare UPIN
TX8006B6Medicare PIN