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Individual

LARRY W DEAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
CRNP

Contact information

Practice address
619 19TH STREET SOUTH, BIRMINGHAM, AL 35233
(205) 934-4011
Mailing address
PO BOX 55310, BIRMINGHAM, AL 35255-5310
(205) 731-9701

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
1-040511
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
051505098
BLUE CROSS
AL
01
051505099
BLUE CROSS
AL
05
051551249
AL
01
500021681
RAILROAD MEDICARE
AL
05
891003450
AL
Enumeration date
06/14/2006
Last updated
05/20/2011
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