MEDICARE: KIMBERLY A DEAN DO

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
1	207Q00000X	Family Medicine Physician	OS5731	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194765214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY A DEAN DO

Provider Business Mailing Address
First Line	:	13787 BELCHER RD S
Second Line	:	SUITE 100
City	:	LARGO
State	:	FL
Zip	:	33771-4065
Country	:	US
Telephone Number	:	727-535-9899
Fax Number	:	727-535-2818

Provider Business Practice Location Address
First Line	:	13787 BELCHER RD S
Second Line	:	SUITE 100
City	:	LARGO
State	:	FL
Zip	:	33771-4065
Country	:	US
Telephone Number	:	727-535-9899
Fax Number	:	727-535-2818

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	10/26/2016

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Directions to “ KIMBERLY A DEAN DO” Practice Location

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