Provider Demographics
NPI:1629074919
Name:DEAN, SCOTT E (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:E
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 1:504 NORTH MACARTHUR AVENUE
Mailing Address - Street 2:NEPHROLOGY ASSOCIATES, P.A.
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-3636
Mailing Address - Country:US
Mailing Address - Phone:850-769-2158
Mailing Address - Fax:850-785-9220
Practice Address - Street 1:504 NORTH MACARTHUR AVENUE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-3636
Practice Address - Country:US
Practice Address - Phone:850-769-2158
Practice Address - Fax:850-785-9220
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME49423207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062622800Medicaid
390001566OtherRRB PTAN
E65242Medicare UPIN
FL062622800Medicaid