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General NPI Number Information
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NPI Number | 1063690527
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Entity Type | Organization
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Legal Business Name | DEAN MCNABB DPM LLC
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Dates
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Enumeration Date | 02/07/2008
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Last Update Date | 06/14/2013
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Provider Practice Location Address
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Address Line | 851 NE BAKER ST SUITE 4
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City | MCMINNVILLE
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State | OR
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Zip | 97128-4991
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Country | US
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Telephone | 503-434-5222
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Fax | 877-878-1984
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Provider Business Mailing Address
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Address Line | PO BOX 20367
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City | KEIZER
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State | OR
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Zip | 97307-0367
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Country | US
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Telephone | 503-390-0959
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Fax | 877-878-1984
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Authorized Official
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Title or Position | OWNER
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Name | EARL DEAN MCNABB
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Credential | DPM
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Telephone | 503-390-0959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | DP00344
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License Number State | OR
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