Provider Demographics
NPI:1447443411
Name:DEAN, CRAIG STEVEN (DO)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:STEVEN
Last Name:DEAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 RAVENSHILL WAY
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-7762
Mailing Address - Country:US
Mailing Address - Phone:386-747-0588
Mailing Address - Fax:
Practice Address - Street 1:227 RAVENSHILL WAY
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-7762
Practice Address - Country:US
Practice Address - Phone:386-747-0588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10145207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAZ415YMedicare Oscar/Certification