Provider Demographics
NPI:1760571764
Name:DEAN, KEVIN JAMES (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:JAMES
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 1:5000 HENNESSY BLVD
Mailing Address - Street 2:1ST FLOOR OF HOSPITAL
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4375
Mailing Address - Country:US
Mailing Address - Phone:225-765-4050
Mailing Address - Fax:225-765-4046
Practice Address - Street 1:5000 HENNESSY BLVD
Practice Address - Street 2:1ST FLOOR OF HOSPITAL
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4375
Practice Address - Country:US
Practice Address - Phone:225-765-4050
Practice Address - Fax:225-765-4046
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD200513207R00000X, 208000000X
LA200513208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1054285Medicaid
203259158OtherPPO PLUS
203259158OtherUNITED HEALTHCARE
203259158OtherHUMANA
6133035OtherCIGNA PPO
9420599OtherPHCS/AMER.LIFECARE
415014OtherCOVENTRY
7008763OtherAETNA
203259158OtherPPO USA/GEHA
6133035OtherCIGNA PPO
LA248272YJA2Medicare PIN
LA4J967CS41Medicare ID - Type Unspecified