MEDICARE: MR. ERIC EDWARD DEAN RPAC

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	363AS0400X	Surgical Physician Assistant	009368-1	NY

General Provider Information

NPI Number	:	1235157355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERIC EDWARD DEAN RPAC

Provider Business Mailing Address
First Line	:	46 DAVISON CT
Second Line	:
City	:	LOCKPORT
State	:	NY
Zip	:	14094-5370
Country	:	US
Telephone Number	:	716-433-2973
Fax Number	:	716-438-9267

Provider Business Practice Location Address
First Line	:	46 DAVISON CT
Second Line	:
City	:	LOCKPORT
State	:	NY
Zip	:	14094-5370
Country	:	US
Telephone Number	:	716-433-2973
Fax Number	:	716-438-9267

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	07/08/2007

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