Provider Demographics
NPI:1790744811
Name:DEAN, DAVID PAUL (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:PAUL
Last Name:DEAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:PAUL
Other - Last Name:DEAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1368
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-8368
Mailing Address - Country:US
Mailing Address - Phone:405-745-9600
Mailing Address - Fax:405-745-9602
Practice Address - Street 1:1 SAINT VINCENT CIR
Practice Address - Street 2:SUITE 120
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5405
Practice Address - Country:US
Practice Address - Phone:501-552-2660
Practice Address - Fax:501-552-4549
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC7913208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR131637001Medicaid
5K409704Medicare PIN
AR131637001Medicaid