Provider Demographics
NPI:1952300345
Name:DEAN, THOMAS M (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
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 1:602 1ST ST NE
Mailing Address - Street 2:
Mailing Address - City:WESSINGTON SPRINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57382-2134
Mailing Address - Country:US
Mailing Address - Phone:605-539-1778
Mailing Address - Fax:605-539-9546
Practice Address - Street 1:602 1ST ST NE
Practice Address - Street 2:
Practice Address - City:WESSINGTON SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57382-2134
Practice Address - Country:US
Practice Address - Phone:605-539-1778
Practice Address - Fax:605-539-9546
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2309207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD2309OtherSTATE LICENSE
D25240Medicare UPIN
5624Medicare PIN