Provider Demographics
NPI:1962481788
Name:DEAN, MICHAEL ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALAN
Last Name:DEAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1003 DIVISION ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1657
Mailing Address - Country:US
Mailing Address - Phone:928-778-7080
Mailing Address - Fax:928-771-9548
Practice Address - Street 1:1003 DIVISION ST
Practice Address - Street 2:SUITE 2
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1657
Practice Address - Country:US
Practice Address - Phone:928-778-7080
Practice Address - Fax:928-771-9548
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ25332207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ887333Medicaid
AZ03 D0976842OtherCLIA
AZ887333Medicaid
AZ03 D0976842OtherCLIA