Healthcare Provider Details

I. General information

NPI: 1871877191
Provider Name (Legal Business Name): WARD DEAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2011
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6708 PLANTATION RD STE C1
PENSACOLA FL
32504
US

IV. Provider business mailing address

5559 N DAVIS HWY STE B
PENSACOLA FL
32503-2068
US

V. Phone/Fax

Practice location:
  • Phone: 850-912-6981
  • Fax: 850-912-6983
Mailing address:
  • Phone: 850-475-2675
  • Fax: 850-475-2679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME 47547
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: