Individual
DOUGLAS DEAN DOCTOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
17321 STATE ROAD 23, SOUTH BEND, IN 46635-1531
(574) 335-8400
(574) 335-0796
Mailing address
707 E CEDAR ST, STE 200, SOUTH BEND, IN 46617-4207
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01036380
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000215746
BCBS
IN
01
—
000000579960
BCBS
IN
05
—
100205190A
—
IN
Enumeration date
05/23/2006
Last updated
01/08/2024
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