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NPI Code Detail

MEDICARE: DANIEL G DEAN PA-C

MEDICARE: DANIEL G DEAN PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA-2003ID

General Provider Information

NPI Number : 1114510062
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIEL G DEAN PA-C
Provider Business Mailing Address
First Line : 633 N 4TH ST
Second Line :
City : BOISE
State : ID
Zip : 83702-4510
Country : US
Telephone Number : 208-342-9800
Fax Number : 208-342-4223
Provider Business Practice Location Address
First Line : 633 N 4TH ST
Second Line :
City : BOISE
State : ID
Zip : 83702-4510
Country : US
Telephone Number : 208-342-9800
Fax Number : 208-342-4223
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2021
Last Update Date : 03/11/2024

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