Healthcare Provider Details

I. General information

NPI: 1124188958
Provider Name (Legal Business Name): RODNEY J DEAN MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3549 SOUTHERN HILLS DR
SIOUX CITY IA
51106-4736
US

IV. Provider business mailing address

3549 SOUTHERN HILLS DR
SIOUX CITY IA
51106-4736
US

V. Phone/Fax

Practice location:
  • Phone: 712-274-6729
  • Fax: 712-274-6744
Mailing address:
  • Phone: 712-274-6729
  • Fax: 712-274-6744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001320
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberA070333
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number01241
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. BETH L WEDE
Title or Position: OFFICE MANAGER
Credential:
Phone: 712-274-6729