Provider Demographics
NPI:1396740015
Name:DEWEY L. DEAN MD PHD PSC
Entity type:Organization
Organization Name:DEWEY L. DEAN MD PHD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PATHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEWEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:270-752-2270
Mailing Address - Street 1:PO BOX 22408
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-0408
Mailing Address - Country:US
Mailing Address - Phone:270-366-0755
Mailing Address - Fax:314-846-0635
Practice Address - Street 1:810 EAST VINE STREET
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071
Practice Address - Country:US
Practice Address - Phone:270-762-1100
Practice Address - Fax:270-752-2290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64088081Medicaid
KYDC0699OtherMEDICARE RAILROAD
KY64088081Medicaid