Provider Demographics
NPI:1922076249
Name:DEAN, JOE A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:A
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 1:500 KELL WEST BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76310-1612
Mailing Address - Country:US
Mailing Address - Phone:940-322-1888
Mailing Address - Fax:
Practice Address - Street 1:500 KELL WEST BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310-1612
Practice Address - Country:US
Practice Address - Phone:940-322-1888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-11
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD8189207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC15135Medicare UPIN
TX00JY52Medicare PIN