Healthcare Provider Details

I. General information

NPI: 1528010022
Provider Name (Legal Business Name): EDWIN JAMES DEAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 GOODLETTE RD NORTH SUITE D-306
NAPLES FL
34102
US

IV. Provider business mailing address

501 GOODLETTE RD NORTH SUITE D-306
NAPLES FL
34102
US

V. Phone/Fax

Practice location:
  • Phone: 239-263-0014
  • Fax:
Mailing address:
  • Phone: 239-263-0014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME60802
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME60802
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: