Provider Demographics
NPI:1255389532
Name:DEAN, ROBERT L (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
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 1:2121 N CRAYCROFT RD BLDG 5
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2801
Mailing Address - Country:US
Mailing Address - Phone:520-296-8500
Mailing Address - Fax:520-733-2389
Practice Address - Street 1:1358 W. ORANGE GROVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704
Practice Address - Country:US
Practice Address - Phone:520-575-1272
Practice Address - Fax:520-575-1789
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32516207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ854861Medicaid
AZZ81790Medicare ID - Type Unspecified
AZZ80458Medicare ID - Type Unspecified
AZI05417Medicare UPIN