Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | H2331 | TX |
NPI | 1013923291 |
---|---|
Provider Name | John Dean |
First Address | Midland, TX 79703-4817 |
Second Address | Midland, TX 79706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 08/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
119245204 | (05) | TX |
8EA043 | BCBS TX (01) | TX |
8X2920 | BC/BS PROVIDER ID (01) | TX |
BD1179919 | DEA (01) | TX |
P00605441 | MEDICARE RAILROAD (01) | TX |