Provider Demographics
NPI:1952545444
Name:DEAN, JONATHAN ALLEN (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ALLEN
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 1:6353 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WILMER
Mailing Address - State:AL
Mailing Address - Zip Code:36587-4453
Mailing Address - Country:US
Mailing Address - Phone:251-410-7425
Mailing Address - Fax:251-649-6200
Practice Address - Street 1:6353 2ND ST
Practice Address - Street 2:
Practice Address - City:WILMER
Practice Address - State:AL
Practice Address - Zip Code:36587-4453
Practice Address - Country:US
Practice Address - Phone:251-410-7425
Practice Address - Fax:251-649-6200
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.30780207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL234688Medicaid
AL235244OtherRURAL HEALTH MEDICAID