Provider Demographics
NPI:1821080854
Name:SHIPPEY, DEAN U (MD)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:U
Last Name:SHIPPEY
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:PO BOX 2175
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75802-2175
Mailing Address - Country:US
Mailing Address - Phone:903-731-9300
Mailing Address - Fax:903-731-9138
Practice Address - Street 1:1600 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:LOVINGTON
Practice Address - State:NM
Practice Address - Zip Code:88260-2813
Practice Address - Country:US
Practice Address - Phone:505-396-7705
Practice Address - Fax:505-396-4465
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2002-01072085R0202X
TXL34742085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM70600261Medicaid
NM70600261Medicaid