Provider Demographics
NPI: | 1639173370 |
---|---|
Name: | STOKES, DEAN H (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | DEAN |
Middle Name: | H |
Last Name: | STOKES |
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: | 830 AINSWORTH DR |
Mailing Address - Street 2: | |
Mailing Address - City: | PRESCOTT |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 86301-1630 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 928-776-0325 |
Mailing Address - Fax: | 928-776-0405 |
Practice Address - Street 1: | 830 AINSWORTH DR |
Practice Address - Street 2: | |
Practice Address - City: | PRESCOTT |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 86301-1630 |
Practice Address - Country: | US |
Practice Address - Phone: | 928-776-0325 |
Practice Address - Fax: | 928-776-0405 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-06-10 |
Last Update Date: | 2019-04-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AZ | 44982 | 207Q00000X, 207N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 0014711250001 | Medicaid | |
PA | 0014711250001 | Medicaid | |
AZ | 153312 | Medicare PIN | |
PA | 143982Q8S | Medicare ID - Type Unspecified | MEDICARE |