Provider Demographics
NPI:1326009952
Name:DEAN, REGINALD C (IDC)
Entity type:Individual
Prefix:MR
First Name:REGINALD
Middle Name:C
Last Name:DEAN
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7119 LANGLEY ST
Mailing Address - Street 2:NAVAL BRANCH HEALTH CLINIC WHITING FIELD
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-6105
Mailing Address - Country:US
Mailing Address - Phone:850-623-7508
Mailing Address - Fax:
Practice Address - Street 1:7119 LANGLEY ST
Practice Address - Street 2:NAVAL BRANCH HEALTH CLINIC WHITING FIELD
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-6105
Practice Address - Country:US
Practice Address - Phone:850-623-7508
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians