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General NPI Number Information
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NPI Number | 1033629811
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Entity Type | Organization
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Legal Business Name | ANDREW M. DALE, MD PLLC
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Dates
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Enumeration Date | 10/05/2017
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Last Update Date | 02/15/2018
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Provider Practice Location Address
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Address Line | 207 LAKE RD
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City | BELTON
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State | TX
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Zip | 76513-1511
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Country | US
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Telephone | 254-831-3172
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Fax | 254-831-3164
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Provider Business Mailing Address
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Address Line | 207 LAKE RD
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City | BELTON
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State | TX
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Zip | 76513-1511
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Country | US
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Telephone | 254-831-3172
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Fax | 254-831-3164
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Authorized Official
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Title or Position | OWNER
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Name | ANDREW DALE
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Credential | MD
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Telephone | 254-831-3172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | K5882
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License Number State | TX
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