Provider Demographics
NPI:1710071170
Name:BRICK, DEAN CLARK (MD)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:CLARK
Last Name:BRICK
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:6422 E SPEEDWAY BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-1148
Mailing Address - Country:US
Mailing Address - Phone:520-325-9400
Mailing Address - Fax:520-325-8965
Practice Address - Street 1:6422 E SPEEDWAY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1148
Practice Address - Country:US
Practice Address - Phone:520-325-9400
Practice Address - Fax:520-325-8965
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ12366207W00000X
CAG35524207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ220921Medicaid
AZZ78565Medicare ID - Type Unspecified
AZD36594Medicare UPIN