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1568463925

NPI Code Detail

MEDICARE: DAVID W DALE D.O.

MEDICARE: DAVID W DALE D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	R3C32	MO
2	261QR1300X	Rural Health Clinic/Center
3	261Q00000X	Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	001013745	OTHER	MO	MEDICARE PART B

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568463925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID W DALE D.O.

Provider Business Mailing Address
First Line	:	PO BOX 817
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63702-0817
Country	:	US
Telephone Number	:	573-335-4715
Fax Number	:	573-334-2303

Provider Business Practice Location Address
First Line	:	1340 S SAM HOUSTON BLVD
Second Line	:
City	:	HOUSTON
State	:	MO
Zip	:	65483-2045
Country	:	US
Telephone Number	:	417-967-3755
Fax Number	:	417-967-2630

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	08/14/2013

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Directions to “ DAVID W DALE D.O.” Practice Location

Language	Start Address	Practice Location

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