Tyler Craig Dean, MD
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · River Ridge, LA
NPI 1063154359 · NPPES record last updated Apr 8, 2022
Key facts
- NPI
- 1063154359
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 801 Moss LN
River Ridge, LA 70123-2941 - Phone
- (504) 330-0353
- NPI assigned
- Apr 8, 2022
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220627000463 | LA | Order and Referring Only - General Surgery |
7012396740 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 331582 | LA | MD | Lactation Consultant (Non-RN) |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
801 Moss LN
River Ridge, LA 70123-2941
Mailing address
801 Moss LN
River Ridge, LA 70123-2941
Phone (504) 330-0353
Other providers in River Ridge, LA
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- Thu T Dang
- Richard Darling III
- Christi Datri
- William Keith De Jong
- Dejong and Plaisance Dentistry Partnership
- Christopher Dicharry
- Eric M Dishongh
- Ashley Brignac Domec
- Donna Marie Doolen
All providers in River Ridge, LA · Student in an Organized Health Care Education/Training Program in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 8, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.