Provider Demographics
NPI:1851483622
Name:PRIEST, DEAN B JR (MD)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:B
Last Name:PRIEST
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 W MONROE AVE STE Q
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-9451
Mailing Address - Country:US
Mailing Address - Phone:479-320-7100
Mailing Address - Fax:844-886-6851
Practice Address - Street 1:213 W MONROE AVE STE Q
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:AR
Practice Address - Zip Code:72745-9451
Practice Address - Country:US
Practice Address - Phone:479-320-7100
Practice Address - Fax:844-886-6851
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE23522084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR139017001Medicaid
AR139017001Medicaid
AR5L359Medicare ID - Type Unspecified