Healthcare Provider Details

I. General information

NPI: 1568546943
Provider Name (Legal Business Name): PHILIP C DEAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 BEATRICE DR
PENSACOLA FL
32514-5867
US

IV. Provider business mailing address

4951 GRANDE DR
PENSACOLA FL
32504-8965
US

V. Phone/Fax

Practice location:
  • Phone: 850-476-7555
  • Fax: 850-466-3777
Mailing address:
  • Phone: 850-473-0100
  • Fax: 850-473-0500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME51177
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: