MEDICARE: DR. JOHN RANDOLPH DEANS M.D.

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	207WX0107X	Retina Specialist (Ophthalmology) Physician	2020-00126	NC
2	207W00000X	Ophthalmology Physician	2020-00126	NC

General Provider Information

NPI Number	:	1407210057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN RANDOLPH DEANS M.D.

Provider Business Mailing Address
First Line	:	1801 NEW HANOVER MEDICAL PARK DR
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-5351
Country	:	US
Telephone Number	:	910-254-2023
Fax Number	:	910-254-0242

Provider Business Practice Location Address
First Line	:	1801 NEW HANOVER MEDICAL PARK DR
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-5351
Country	:	US
Telephone Number	:	910-254-2023
Fax Number	:	910-254-0242

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

Provider Enumeration Date	:	04/11/2016
Last Update Date	:	01/10/2023

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