Individual
CHARLES L. DEAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1301 W 18TH ST, SIOUX FALLS, SD 57105-0401
(605) 312-2200
(605) 312-2205
Mailing address
1301 W 18TH ST, SIOUX FALLS, SD 57105-0401
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0956
SD
363A00000X
Physician Assistant
Primary
2006031509
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200096650A
—
OK
05
—
200406410A
—
KS
01
—
214924
ANTHEM
MO
05
—
220083022
—
MO
01
—
P00350032
RR MEDICARE
—
Enumeration date
10/12/2006
Last updated
03/09/2023
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