Provider Demographics
NPI:1679802128
Name:O JOSEPH DEAN JR MD PA
Entity type:Organization
Organization Name:O JOSEPH DEAN JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ODELL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:936-634-8765
Mailing Address - Street 1:302 MEDICAL PARK DR
Mailing Address - Street 2:STE 104
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3148
Mailing Address - Country:US
Mailing Address - Phone:936-634-8765
Mailing Address - Fax:936-639-4258
Practice Address - Street 1:302 MEDICAL PARK DR
Practice Address - Street 2:STE 104
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3148
Practice Address - Country:US
Practice Address - Phone:936-634-8765
Practice Address - Fax:936-639-4258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-11
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9656208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089919702Medicaid
TXTXB103904Medicare PIN
TX089919702Medicaid