Provider Demographics
NPI:1285802363
Name:DEAN, BETH PAYNE (PA-C)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:PAYNE
Last Name:DEAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13555 W MCDOWELL RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2624
Mailing Address - Country:US
Mailing Address - Phone:623-935-5522
Mailing Address - Fax:623-935-3220
Practice Address - Street 1:13555 W MCDOWELL RD
Practice Address - Street 2:SUITE 304
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2624
Practice Address - Country:US
Practice Address - Phone:623-935-5522
Practice Address - Fax:623-935-3220
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3804363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3804OtherPHYSICIAN ASSIST LICENSE
1077836OtherNCCPA
AZ366422Medicaid
AZ366422Medicaid