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General NPI Number Information
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NPI Number | 1619274388
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Entity Type | Organization
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Legal Business Name | DEAN MEDICAL INC
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Dates
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Enumeration Date | 02/16/2011
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Last Update Date | 11/05/2023
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Provider Practice Location Address
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Address Line | 1500 LAKELAND HILLS BLVD STE 4
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City | LAKELAND
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State | FL
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Zip | 33805-3257
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Country | US
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Telephone | 863-937-7157
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Fax | 863-333-0260
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Provider Business Mailing Address
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Address Line | 3616 HARDEN BLVD # 311
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City | LAKELAND
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State | FL
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Zip | 33803-5938
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Country | US
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Telephone | 863-937-7157
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Fax | 863-333-0260
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. BYRON RENARD DEAN
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Credential | D.O.
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Telephone | 863-937-7157
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS9203
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License Number State | FL
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