Provider Demographics
NPI:1538181680
Name:MCCARLEY, DEAN LATAIN (MD)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:LATAIN
Last Name:MCCARLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6303 NW 128TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-2612
Mailing Address - Country:US
Mailing Address - Phone:352-246-7284
Mailing Address - Fax:
Practice Address - Street 1:6303 NW 128TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-2612
Practice Address - Country:US
Practice Address - Phone:352-246-7284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME31192207R00000X, 207RH0000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL051865OtherVISTA
FL066428600Medicaid
FL209879OtherAVMED
FL55093OtherBCBS
FLD56720Medicare UPIN
FL55093VMedicare PIN