Healthcare Provider Details

I. General information

NPI: 1326051954
Provider Name (Legal Business Name): DALE GENE OBRIEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 FOUNTAIN AVE
PACIFIC GROVE CA
93950-3412
US

IV. Provider business mailing address

312 FOUNTAIN AVE
PACIFIC GROVE CA
93950-3412
US

V. Phone/Fax

Practice location:
  • Phone: 831-658-0600
  • Fax: 831-658-0518
Mailing address:
  • Phone: 831-658-0600
  • Fax: 831-658-0518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG28681
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: