Healthcare Provider Details

I. General information

NPI: 1972584936
Provider Name (Legal Business Name): PHILLIP A DEAN M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 TALBOT RD S STE 420
RENTON WA
98055-5791
US

IV. Provider business mailing address

3600 LIND AVE SW SUITE 100 ATTN CREDENTIALING
RENTON WA
98057-4970
US

V. Phone/Fax

Practice location:
  • Phone: 425-690-3401
  • Fax: 425-690-9401
Mailing address:
  • Phone: 425-690-2715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberMD60513550
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: