Provider Demographics
NPI:1770581357
Name:BRIGHT, DEAN E (DPM)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:E
Last Name:BRIGHT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 W SUNSET AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-5136
Mailing Address - Country:US
Mailing Address - Phone:479-750-3131
Mailing Address - Fax:479-750-9631
Practice Address - Street 1:1670 W SUNSET AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-5136
Practice Address - Country:US
Practice Address - Phone:479-750-3131
Practice Address - Fax:479-750-9631
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR131213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR123529717Medicaid
AR59943OtherARKANSAS BLUE CROSS BLUE
AR14707000000OtherQUAL CHOICE
AR0932990001Medicare NSC
U24894Medicare UPIN
AR59943OtherARKANSAS BLUE CROSS BLUE
59943Medicare ID - Type Unspecified