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NPI Code Detail

MEDICARE: DEAN MCNABB DPM LLC

MEDICARE: DEAN MCNABB DPM LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213ES0103XFoot & Ankle Surgery PodiatristDP00344OR

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2118186OTHERORMEDICARE MAC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063690527
Entity Type Code : Organization
Provider Name (Legal Business Name) : DEAN MCNABB DPM LLC
Provider Business Mailing Address
First Line : PO BOX 20367
Second Line :
City : KEIZER
State : OR
Zip : 97307-0367
Country : US
Telephone Number : 503-390-0959
Fax Number : 877-878-1984
Provider Business Practice Location Address
First Line : 851 NE BAKER ST
Second Line : SUITE 4
City : MCMINNVILLE
State : OR
Zip : 97128-4991
Country : US
Telephone Number : 503-434-5222
Fax Number : 877-878-1984
Authorized Official
Title or Position : OWNER
Name : EARL DEAN MCNABB
Credential : DPM
Telephone Number : 503-390-0959
Provider Enumeration Date : 02/07/2008
Last Update Date : 06/14/2013

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Directions to “DEAN MCNABB DPM LLC ” Practice Location

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