Provider Demographics
NPI:1669459608
Name:DEAN, MARK FRED (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:FRED
Last Name:DEAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1245 WESTGATE PKWY
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303
Mailing Address - Country:US
Mailing Address - Phone:334-793-9595
Mailing Address - Fax:334-793-1578
Practice Address - Street 1:1245 WESTGATE PKWY
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303
Practice Address - Country:US
Practice Address - Phone:334-793-9595
Practice Address - Fax:334-793-1578
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-30
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL9377207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C72158Medicare UPIN