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General NPI Number Information
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NPI Number | 1154612869
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Entity Type | Organization
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Legal Business Name | DALE L. SYVERSON, MD, INC
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Dates
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Enumeration Date | 04/28/2011
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Last Update Date | 04/28/2011
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Provider Practice Location Address
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Address Line | 1825 MAIN ST
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City | SUSANVILLE
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State | CA
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Zip | 96130-4518
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Country | US
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Telephone | 530-252-4115
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Fax | 530-252-4116
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Provider Business Mailing Address
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Address Line | 1825 MAIN ST
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City | SUSANVILLE
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State | CA
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Zip | 96130-4518
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Country | US
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Telephone | 530-252-4115
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Fax | 530-252-4116
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | TERESA MARIA GARATE
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Credential |
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Telephone | 530-252-4115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G87246
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License Number State | CA
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