Provider Demographics
NPI:1912196411
Name:DEANER, MICHAEL HAYDN (IDC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:HAYDN
Last Name:DEANER
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS COWPENS
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96662
Mailing Address - Country:JP
Mailing Address - Phone:0118146-816-2839
Mailing Address - Fax:
Practice Address - Street 1:USS COWPENS
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96662
Practice Address - Country:JP
Practice Address - Phone:0118146-816-2839
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-20
Last Update Date:2007-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman