MEDICARE: DR. ROBERT KYLE DEAN M.D.

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
1	207Q00000X	Family Medicine Physician	11621R	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11621R	OTHER	LA	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	72-0537628	OTHER	LA	TAX ID

General Provider Information

NPI Number	:	1659418325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT KYLE DEAN M.D.

Provider Business Mailing Address
First Line	:	6613 BRYCE CANYON DR S
Second Line	:
City	:	GREENWELL SPRINGS
State	:	LA
Zip	:	70739-3159
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18901 GREENWELL SPRINGS RD
Second Line	:
City	:	GREENWELL SPRINGS
State	:	LA
Zip	:	70739-4836
Country	:	US
Telephone Number	:	225-924-9985
Fax Number	:	225-924-0884

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	01/10/2023

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