Healthcare Provider Details

I. General information

NPI: 1750584686
Provider Name (Legal Business Name): DALE GARDNER BRITT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4727 SHEEHAN LN
SANTA ROSA CA
95404-9743
US

IV. Provider business mailing address

4727 SHEEHAN LN
SANTA ROSA CA
95404-9743
US

V. Phone/Fax

Practice location:
  • Phone: 707-545-3724
  • Fax: 707-575-7670
Mailing address:
  • Phone: 707-545-3724
  • Fax: 707-575-7670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberC42306
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC42306
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: