Healthcare Provider Details

I. General information

NPI: 1578579249
Provider Name (Legal Business Name): DALE W BLOCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 08/22/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 W. PONCA ST
LYNCH NE
68746
US

IV. Provider business mailing address

PO BOX 345 317 W. PONCA ST
LYNCH NE
68746
US

V. Phone/Fax

Practice location:
  • Phone: 402-569-2741
  • Fax: 402-469-2780
Mailing address:
  • Phone: 402-569-2741
  • Fax: 402-569-2780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number15140
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: