Healthcare Provider Details

I. General information

NPI: 1417681024
Provider Name (Legal Business Name): NORMAN DOUGLAS DEEN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 01/22/2024
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 WEBER ST
FRANKLIN LA
70538-4124
US

IV. Provider business mailing address

5850 E STILL CIR
MESA AZ
85206-3618
US

V. Phone/Fax

Practice location:
  • Phone: 337-828-2550
  • Fax:
Mailing address:
  • Phone: 480-219-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: