Provider Demographics
NPI:1912255621
Name:DEAN, JAMES (M D)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:DEAN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 BROWNS LN
Mailing Address - Street 2:C-17
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1520
Mailing Address - Country:US
Mailing Address - Phone:502-452-9855
Mailing Address - Fax:
Practice Address - Street 1:4121 BROWNS LN
Practice Address - Street 2:C-17
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1520
Practice Address - Country:US
Practice Address - Phone:502-452-9855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY15851207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine