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General NPI Number Information
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NPI Number | 1316938350
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Entity Type | Individual
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Provider Name | DALE M AHRENDT M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/31/2005
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Last Update Date | 08/11/2020
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Provider Practice Location Address
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Address Line | 3551 ROGER BROOKE DR
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City | FORT SAM HOUSTON
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State | TX
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Zip | 78234-4504
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Country | US
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Telephone | 210-916-4735
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Fax | 210-916-6349
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Provider Business Mailing Address
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Address Line | BROOKE ARMY MEDICAL CENTER MCHE-QD/ CREDENTIALS 3551 ROGER BROOKE DRIVE
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City | FORT SAM HOUSTON
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State | TX
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Zip | 78234-6200
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Country | US
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Telephone | 210-916-4735
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Fax | 210-916-6349
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 4234
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License Number State | SD
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