Healthcare Provider Details

I. General information

NPI: 1619963691
Provider Name (Legal Business Name): DALE N FINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 04/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6411 E CROCUS DR
SCOTTSDALE AZ
85254-3353
US

IV. Provider business mailing address

6411 E CROCUS DR
SCOTTSDALE AZ
85254-3353
US

V. Phone/Fax

Practice location:
  • Phone: 480-208-9408
  • Fax:
Mailing address:
  • Phone: 480-208-9408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD00014761
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00014761
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: