Provider Demographics
NPI:1053765784
Name:DEAN, AUDREY (MD)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 E 3900 S STE 450
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1349
Mailing Address - Country:US
Mailing Address - Phone:801-262-3600
Mailing Address - Fax:618-822-4039
Practice Address - Street 1:1250 E 3900 S STE 450
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1349
Practice Address - Country:US
Practice Address - Phone:801-262-3600
Practice Address - Fax:618-822-4039
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13785870-1205207N00000X
PAMD471465207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology