Healthcare Provider Details

I. General information

NPI: 1720008394
Provider Name (Legal Business Name): JOHN W DEAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 N WABASH AVE
MARION IN
46952-2612
US

IV. Provider business mailing address

PO BOX 2469
INDIANAPOLIS IN
46206-2469
US

V. Phone/Fax

Practice location:
  • Phone: 765-662-1441
  • Fax:
Mailing address:
  • Phone: 866-494-8259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME170906
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number1047076A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: