Healthcare Provider Details

I. General information

NPI: 1336238781
Provider Name (Legal Business Name): DALE J. WILMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 INDEPENDENCE CIR SUITE 1
CHICO CA
95973-4918
US

IV. Provider business mailing address

130 INDEPENDENCE CIR SUITE 1
CHICO CA
95973-4918
US

V. Phone/Fax

Practice location:
  • Phone: 530-343-5864
  • Fax: 530-343-8370
Mailing address:
  • Phone: 530-343-5864
  • Fax: 530-343-8370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG31430
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: