Provider Demographics
NPI:1659418325
Name:DEAN, ROBERT KYLE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KYLE
Last Name:DEAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6613 BRYCE CANYON DR S
Mailing Address - Street 2:
Mailing Address - City:GREENWELL SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70739-3159
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18901 GREENWELL SPRINGS RD
Practice Address - Street 2:
Practice Address - City:GREENWELL SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70739-4836
Practice Address - Country:US
Practice Address - Phone:225-924-9985
Practice Address - Fax:225-924-0884
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11621R207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA11621ROtherSTATE LICENSE
LA1695467Medicaid
LA72-0537628OtherTAX ID
LA11621ROtherSTATE LICENSE
LA5B061Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
LA72-0537628OtherTAX ID