Provider Demographics
NPI:1285250621
Name:DEAN, BROOKE ERICA (MD)
Entity type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:ERICA
Last Name:DEAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E 9TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:PANA
Mailing Address - State:IL
Mailing Address - Zip Code:62557-1785
Mailing Address - Country:US
Mailing Address - Phone:217-562-2544
Mailing Address - Fax:573-642-3015
Practice Address - Street 1:101 E 9TH ST STE 105
Practice Address - Street 2:
Practice Address - City:PANA
Practice Address - State:IL
Practice Address - Zip Code:62557-1785
Practice Address - Country:US
Practice Address - Phone:217-562-2544
Practice Address - Fax:573-642-3015
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020015976207Q00000X
IL036.167153207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine