Provider Demographics
NPI:1962465518
Name:ADELMAN, DEAN BARRY (DO)
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:BARRY
Last Name:ADELMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4780 SW 64TH AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-4400
Mailing Address - Country:US
Mailing Address - Phone:954-434-1705
Mailing Address - Fax:954-424-0765
Practice Address - Street 1:350 NW 84TH AVE STE 200A
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1817
Practice Address - Country:US
Practice Address - Phone:954-424-4321
Practice Address - Fax:954-424-0765
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC514207Q00000X
FLOS17044207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110709400Medicaid
SC005149Medicaid
SC005149Medicaid