Provider Demographics
NPI:1568516599
Name:HARVIE, DEAN B (PA)
Entity type:Individual
Prefix:MR
First Name:DEAN
Middle Name:B
Last Name:HARVIE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7125 NEW SANGER AVE STE A
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-4054
Mailing Address - Country:US
Mailing Address - Phone:254-399-5400
Mailing Address - Fax:254-772-4641
Practice Address - Street 1:7125 NEW SANGER AVE STE A
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-4054
Practice Address - Country:US
Practice Address - Phone:254-399-5400
Practice Address - Fax:254-772-4641
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05161363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186786301Medicaid
TXP00715821OtherRRMCR
TXP00715821OtherRRMCR